Ultrasound in Obstetrics and Gynecology via MedWorm.com

Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate: a systematic review

Ultrasound in Obstetrics and Gynecology — Wed, 17 Mar 2010 00:00:00 +0100

To systematically review the diagnostic accuracy of second-trimester transabdominal ultrasound in detecting orofacial clefts in low- and high-risk populations and to compare two-dimensional (2D) with three-dimensional (3D) ultrasound techniques.MEDLINE and EMBASE were searched for articles published in English, Dutch, French or German using the keywords 'cleft' and 'ultrasound' or 'screening' or 'sonogram' and 'prenatal' or 'antenatal' or 'fetus' to identify cohort studies and randomized trials in order to assess the detection rate by prenatal ultrasound of cleft lip and palate in high-risk and low-risk pregnant women.Of 451 citations identified, 27 met the criteria for the systematic review, 21 involving unselected low-risk populations and six involving high-risk populations. In the selec...

Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis

Ultrasound in Obstetrics and Gynecology — Mon, 15 Mar 2010 00:00:00 +0100

To estimate the effectiveness of cerclage according to degree of cervical length (CL) shortening.A meta-analysis was carried out of trials of women with singleton gestations and second-trimester transvaginal sonographic CL < 25 mm randomized to cerclage or no cerclage. The degree of CL shortening was correlated to the efficacy of cerclage in preventing preterm birth.There was a significant reduction in preterm birth < 35 weeks in the cerclage compared with no cerclage groups in 208 singleton gestations with both a previous preterm birth and CL < 25 mm (relative risk, 0.61; 95% CI, 0.40-0.92). In these women, preterm birth < 37 weeks was significantly reduced with cerclage for CL [les] 5.9 mm, [les] 15.9 mm, 16-24.9 mm and < 25 mm. None of the analyses for 344 women without a previous prete...

Large fetal size in early pregnancy associated with macrosomia

Ultrasound in Obstetrics and Gynecology — Sat, 13 Mar 2010 00:00:00 +0100

To assess if fetal size at the time of ultrasound dating examination is associated with the risk of macrosomia and complications associated with macrosomia.This was a retrospective cohort study of 19 377 singleton pregnancies dated in gestational weeks 16-20 during the period 1998-2004 at Danderyd Hospital, Stockholm, Sweden. Obstetric outcome was assessed through linkage to the Swedish Medical Birth Register.When fetuses were [ge] 7 days larger than expected at dating, compared with the expected size according to last menstrual period, there was a 59% increase in the risk of birth weight [ge] 4500 g and a 145% increase in the risk of birth weight [ge] 5000 g (odds ratio (OR), 1.59; 95% CI, 1.12-2.24 and OR, 2.45; 95% CI, 1.22-4.90, respectively). For a birth weight of [ge] 4000 g the risk...

A technical tip on scanning obese gravidae

Ultrasound in Obstetrics and Gynecology — Tue, 09 Mar 2010 00:00:00 +0100

How do we do it?Practical advice on imaging-based techniques and investigations (Source: Ultrasound in Obstetrics and Gynecology)

Transvaginal mesh repair of anterior and posterior vaginal wall prolapse: a clinical and ultrasonographic study

Ultrasound in Obstetrics and Gynecology — Sat, 06 Mar 2010 00:00:00 +0100

To investigate whether ultrasonography coupled with clinical examination can help in understanding the mechanism of recurrence after transvaginal mesh repair of anterior and posterior vaginal wall prolapse.Ninety-one patients who had undergone surgery for anterior and/or posterior vaginal wall prolapse with the Prolift system had a clinical examination and introital/endovaginal two-dimensional ultrasonography a minimum of 1 year later. The retraction of anterior and posterior meshes was estimated relative to the original length of the mesh by transvaginal palpation. Patients with no, moderate (< 50%) or severe ([ge] 50%) mesh retraction were compared. Anterior recurrence of prolapse was defined according to the International Continence Society by a Ba value [ge] -1 and posterior recurrence...

Erratum: Song MS, Hu A, Dyhamenahali U, Chitayat D, Winsor EJT, Ryan G, Smallhorn J, Barrett J, Yoo S-J, Hornberger LK. Extracardiac lesions and chromosomal abnormalities associated with major fetal heart defects: comparison of intrauterine, postnatal and postmortem diagnoses. Ultrasound Obstet Gynecol 2009; 33: 552-559

Ultrasound in Obstetrics and Gynecology — Thu, 04 Mar 2010 00:00:00 +0100

The original article to which this Errata refers was published in Ultrasound in Obstetrics and Gynecology, 2009; 33: 552-559 (Source: Ultrasound in Obstetrics and Gynecology)

13-14-week fetal anatomy scan: a 5-year prospective study

Ultrasound in Obstetrics and Gynecology — Thu, 04 Mar 2010 00:00:00 +0100

To assess the potential value of an early (first-trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid-trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.In this prospective study over a 5-year period (January 2002 to January 2007) 2876 pregnant women underwent a 13-14-week ultrasound examination. The scan was performed by TAS at first and then, if a full fetal anatomical survey was not achieved, by TVS. A mid-trimester fetal anatomy scan was then performed in patients who had not dropped out, miscarried or undergone pregnancy termination (n = 2834).In the early scan, analyzable data for 2876 TAS and ...

The added value of 3D/4D ultrasound imaging in fetal cardiology: has the promise been fulfilled?

Ultrasound in Obstetrics and Gynecology — Thu, 04 Mar 2010 00:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Congenital malformations after assisted reproduction: risks and implications for prenatal diagnosis and fetal medicine

Ultrasound in Obstetrics and Gynecology — Mon, 01 Mar 2010 00:00:00 +0100

(Source: Ultrasound in Obstetrics and Gynecology)

Acoustic streaming cannot discriminate reliably between endometriomas and other types of adnexal lesion: a multicenter study of 633 adnexal masses

Ultrasound in Obstetrics and Gynecology — Wed, 17 Feb 2010 00:00:00 +0100

To determine the ability of acoustic streaming to discriminate between endometriomas and other adnexal masses.We used data from 1938 patients with an adnexal mass included in Phase 2 of the International Ovarian Tumor Analysis (IOTA) study. All patients had been examined by transvaginal gray-scale and Doppler ultrasound following a standardized research protocol. Assessment of acoustic streaming was voluntary and was carried out only in lesions containing echogenic cyst fluid. Acoustic streaming was defined as movement of particles inside the cyst fluid during gray-scale and/or color Doppler examination provided that the probe had been held still for two seconds to ensure that the movement of the particles was not caused by movement of the probe or the patient. Only centers where acoustic ...

Abnormal first-trimester ductus venosus blood flow: a marker of cardiac defects in fetuses with normal karyotype and nuchal translucency

Ultrasound in Obstetrics and Gynecology — Mon, 15 Feb 2010 00:00:00 +0100

In this study, the use of DV blood flow assessment increased early detection of CHD by 11% with respect to the use of NT measurement alone. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Significance and outcome of left heart hypoplasia in fetal congenital diaphragmatic hernia

Ultrasound in Obstetrics and Gynecology — Tue, 09 Feb 2010 00:00:00 +0100

The objective of this study was to investigate whether small left heart dimensions prenatally normalize after birth in patients with CDH, or whether prenatal indices of left heart size and flow predict postnatal outcome.Clinical and echocardiographic data were reviewed for patients diagnosed with left-sided CDH prenatally. Cardiac dimensions and flows were compared with normative data. Among liveborn patients, pre- and postnatal Z-scores of left heart structures were compared, and associations between prenatal indices and outcome were assessed.Of 125 patients diagnosed prenatally with CDH, 111 had a left-sided defect. Of these, 85 were liveborn, including 20 with congenital heart disease. Gestational age-adjusted dimensions of fetal left heart structures, including aortic valve diameter, m...

Prenatal diagnosis of an isolated skin tumor of the chin

Ultrasound in Obstetrics and Gynecology — Mon, 01 Feb 2010 00:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Intra- and interobserver repeatability of fetal cardiac examination using four-dimensional spatiotemporal image correlation in each trimester of pregnancy

Ultrasound in Obstetrics and Gynecology — Mon, 01 Feb 2010 00:00:00 +0100

To assess the intra- and interobserver repeatability of the evaluation of fetal cardiac structures and measurements using spatiotemporal image correlation (STIC) technology in each trimester of pregnancy.Four-dimensional (4D)-STIC volumes from 150 low-risk pregnancies were acquired at first-, second- or third-trimester scan for later analysis by two different reviewers. A total of 19 items, including the evaluation of 14 structures as well as five measurements of the fetal heart, were evaluated. The reliability of qualitative variables was evaluated using Cohen's kappa and absolute agreement analysis while that of quantitative parameters was assessed using the intraclass correlation coefficient (ICC).Forty-five, 47 and 47 STIC volumes were included in the final analysis from the first, sec...

Prenatal diagnosis of Berry syndrome by fetal echocardiography

Ultrasound in Obstetrics and Gynecology — Tue, 26 Jan 2010 00:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Influence of nuchal cord on ductus venosus assessment at 11 to 13 + 6 weeks' gestation

Ultrasound in Obstetrics and Gynecology — Tue, 26 Jan 2010 00:00:00 +0100

To assess the influence of the presence of nuchal cord (NC) on the evaluation of the fetal ductus venosus flow velocity waveform (DV-FVW).This prospective study included 1174 normal non-selected singleton pregnancies between 11 and 13 + 6 weeks' gestation. We recorded the presence or absence of NC around the fetal neck, and assessed its relationship with the qualitative assessment and quantitative measurement of the DV-FVW.We observed NC around the fetal neck in 6.73% of cases and detected reversed flow of the a-wave of the DV-FVW in 2.98% of cases. In the group without NC, 21 of 1095 had reversed flow in the DV-FVW (1.9%; 95% CI, 1.28-3.02), whereas in the group with NC, 14 of 79 had reversed flow in the DV-FVW (17.7%; 95% CI, 16.67-40.35). We found a lower pulsatility index in fetuses wi...

Three-dimensional ultrasound of the pelvic floor 2 days after first delivery: influence of constitutional and obstetric factors

Ultrasound in Obstetrics and Gynecology — Mon, 18 Jan 2010 00:00:00 +0100

Morphological changes of the pelvic floor during pregnancy and delivery can be visualized by three-dimensional (3D) perineal ultrasound. The aim of this study was to compare biometric measurements of the levator ani muscle according to maternal constitutional factors, delivery mode and size of the baby immediately after the first delivery.In this prospective observational study, 130 primiparae were recruited (all of them Caucasians with singleton pregnancy and cephalic presentation). A 3D perineal ultrasound scan was performed on the second day after delivery with standardized settings. Volumes were obtained at rest and on Valsalva maneuver, and biometric measurements of the levator hiatus were determined in the axial plane. Different obstetric and constitutional parameters were obtained f...

Quantitative three-dimensional power Doppler angiography: a flow-free phantom experiment to evaluate the relationship between color gain, depth and signal artifact

Ultrasound in Obstetrics and Gynecology — Mon, 18 Jan 2010 00:00:00 +0100

To evaluate the presence of false flow three-dimensional (3D) power Doppler signals in 'flow-free' models.3D power Doppler datasets were acquired from three different flow-free phantoms (muscle, air and water) with two different transducers and Virtual Organ Computer-aided AnaLysis was used to generate a sphere that was serially applied through the 3D dataset. The vascularization flow index was used to compare artifactual signals at different depths (from 0 to 6 cm) within the different phantoms and at different gain and pulse repetition frequency (PRF) settings.Artifactual Doppler signals were seen in all phantoms despite these being flow-free. The pattern was very similar and the degree of artifact appeared to be dependent on the gain and distance from the transducer. False signals were ...

Validation of volume measurements for fetal echocardiography using four-dimensional ultrasound imaging and spatiotemporal image correlation

Ultrasound in Obstetrics and Gynecology — Mon, 18 Jan 2010 00:00:00 +0100

To assess the accuracy and reliability of four-dimensional (4D) ultrasound imaging using spatiotemporal image correlation (STIC) employing three different techniques to measure volumes in vitro.Customized miniature balloons attached to a pump system were used to mimic fetal cardiac chambers. After the balloon model had been immersed in a bath filled with viscous gel, 4D datasets were acquired and three methods were used for volume analysis: three dimensional (3D) slice method, Virtual Organ Computer-aided AnaLysis (VOCALTM) and VOCAL combined with inversion mode. Accuracy and measurement error were measured as the difference between the volume measurements and the actual volumes. Intraobserver reliability was assessed by computing coefficients of variation (CV) and intraclass correlation (...

The natural history of fibroids

Ultrasound in Obstetrics and Gynecology — Tue, 12 Jan 2010 00:00:00 +0100

Fibroids are common, hormone-dependent, benign uterine tumors. They can cause significant morbidity and the symptoms depend largely on their size. The aim of this study was to describe the natural history of fibroids and identify factors that may influence their growth.This was a retrospective longitudinal study of premenopausal women who were diagnosed with uterine fibroids on ultrasound examination. All women underwent at least two transvaginal ultrasound scans, which were all performed by a single operator. Fibroids were measured in three perpendicular planes and the mean diameter was calculated. The size and position of every individual fibroid was assessed and recorded on a computerized database. The volume of each fibroid was calculated using the formula for a sphere.A total of 122 w...

Cord entanglement and perinatal outcome in monoamniotic twin pregnancies

Ultrasound in Obstetrics and Gynecology — Tue, 12 Jan 2010 00:00:00 +0100

To assess the prevalence of cord entanglement and perinatal outcome in a large series of monoamniotic twin pregnancies and to review the recent literature on similar published large series.Prospective observational study of all prenatally detected cases of monoamniotic twin pregnancies during an 8-year period in a tertiary fetal medicine unit. A Medline database review for publications since 2000 containing five or more cases of monoamniotic pregnancies that showed data on cord entanglement and perinatal outcome was also undertaken.A total of 32 monoamniotic pregnancies were diagnosed during the study period, including three conjoined twins, seven pregnancies with twin reversed arterial perfusion (TRAP) syndrome, three surgical pregnancy interruptions for discordant fetal abnormality and o...

Tricuspid atresia with absent pulmonary valve and intact ventricular septum: intrauterine course and outcome of an unusual congenital heart defect

Ultrasound in Obstetrics and Gynecology — Tue, 12 Jan 2010 00:00:00 +0100

We report on the intrauterine course of a case diagnosed at 17 weeks of gestation that had a favorable postnatal outcome after palliation. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Chorioamnion plugging and the risk of preterm premature rupture of membranes after laser surgery in twin-twin transfusion syndrome

Ultrasound in Obstetrics and Gynecology — Wed, 06 Jan 2010 00:00:00 +0100

To examine the incidence of preterm premature rupture of membranes (PPROM) in pregnancies affected by twin-twin transfusion syndrome (TTTS) treated with laser photocoagulation where an absorbable gelatin sponge was used as a chorioamnion sealant of the fetoscopic access port.A retrospective review was undertaken of consecutive cases undergoing fetoscopic directed laser surgery for TTTS between October 2006 and November 2008 at Texas Children's Fetal Center, in which an absorbable gelatin sponge, used as a chorioamnion 'plug', was placed at the conclusion of the intervention as a possible prophylactic measure to prevent PPROM. We excluded cases that had a failure of plug placement and those in which it was not attempted. PPROM was defined as rupture of membranes before 34 weeks' gestation. ...

Expectant management of spontaneous first-trimester miscarriage: prospective validation of the '2-week rule'

Ultrasound in Obstetrics and Gynecology — Wed, 06 Jan 2010 00:00:00 +0100

To assess uptake and success of expectant management of first-trimester miscarriage for a finite 14-day period, in order to evaluate our '2-week rule' of management.This was a prospective observational study evaluating our proposed 2-week rule of expectant management, which is based on the finding that women managed expectantly are most likely to miscarry in the first 14 days and that to wait longer than 2 weeks without intervention does not confer a greater chance of successful resolution. Eligible women diagnosed with first-trimester miscarriage were offered a choice of expectant management or surgical evacuation under general anesthesia. Inclusion criteria for expectant management were: diagnosis of incomplete miscarriage (heterogeneous tissue, with or without a gestational sac, seen on...

Placental growth factor in the first trimester: relationship with maternal factors and placental Doppler studies

Ultrasound in Obstetrics and Gynecology — Tue, 05 Jan 2010 00:00:00 +0100

Placental growth factor (PlGF) is a potent angiogenic factor that impacts on early placental vascular development. It was our aim to clarify relationships between PlGF and first-trimester maternal/placental factors that are related to placental development.Prospectively enrolled patients at 11-14 weeks' gestation had serum PlGF measurement by enzyme-linked immunosorbent assay. Results were related to maternal age, parity, race, body mass index, mean arterial blood pressure (MAP), smoking/caffeine use and parameters of placental blood flow resistance.In 110 consecutive patients PlGF levels ranged between 1.0 and 176.1 pg/mL, showing a linear relationship with gestational age (GA) (PlGF = (1.4251 × GA) -74.951, r2 = 0.0765, F = 8.941, P = 0.03). PlGF did not relate to maternal demographics ...

Umbilical vein anomaly in fetuses with Down syndrome

Ultrasound in Obstetrics and Gynecology — Tue, 05 Jan 2010 00:00:00 +0100

To describe the prevalence of abnormal umbilical vein (UV) anatomy in fetuses with Down syndrome.This was a retrospective survey covering a 24-month period of fetuses with a genetic diagnosis of Down syndrome following a routine early second-trimester (12-16-week) detailed fetal anomaly scan at a single academic tertiary referral center. In our unit this exam includes fetal umbilicoportal venous system evaluation.During the study period, 37 fetuses were diagnosed with Down syndrome and had a detailed early anatomy scan. In four (11%) the detailed early anomaly scan revealed that the UV was connected to the hepatic portion of the inferior vena cava (IVC) at a position lower than its usual site. Their average gestational age at diagnosis was 13 + 6 (range, 11 + 6 to 15 + 2) weeks. Three of t...

Comparison of first-trimester contingent screening strategies for Down syndrome

Ultrasound in Obstetrics and Gynecology — Tue, 05 Jan 2010 00:00:00 +0100

To assess the relative performance of a multi-stage first-trimester screening protocol for fetal Down syndrome.Data from 10 767 women who underwent combined ultrasound and biochemistry (BC) screening in the first trimester were reanalyzed using a contingent model approach. Amongst the 10 854 fetuses with known outcome, 32 had Down syndrome, 232 had other abnormalities and 10 590 were unaffected. Nuchal transluceny (NT), BC and combined (NT-BC) gestational age-specific risks were calculated for each individual using The Fetal Medicine Foundation risk calculation algorithms (Mixture Model and Biochemistry). Individual patients were categorized as at low, high or intermediate risk according to one of the following three strategies. In 'Strategy-NT-BC' initial screening was performed using bot...

Ultrasonographic prediction of homozygous [alpha]0-thalassemia using placental thickness, fetal cardiothoracic ratio and middle cerebral artery Doppler: alone or in combination?

Ultrasound in Obstetrics and Gynecology — Tue, 05 Jan 2010 00:00:00 +0100

To compare the predictive values of three ultrasonographic parameters: placental thickness (PT), fetal cardiothoracic ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV), alone or in combination, in pregnancies affected by homozygous [alpha]0-thalassemia at 12-20 weeks' gestation.Pregnant women at risk of carrying a fetus affected by homozygous [alpha]0-thalassemia were studied from 1995 to 2006 using serial ultrasonography at 12-15 weeks, 16-20 weeks and 30 weeks' gestation. We measured CTR and PT from 1995, and MCA-PSV as well from 1997. An invasive prenatal test was offered if cardiomegaly with or without placentomegaly was detected but the MCA-PSV results were used only retrospectively for analysis.Of a total of 777 at-risk fetuses studied, 138 (17.8%) were affected...

Nuchal translucency and cystic hygroma colli in screening for fetal major congenital heart defects in a series of 12 910 euploid pregnancies

Ultrasound in Obstetrics and Gynecology — Tue, 22 Dec 2009 00:00:00 +0100

Many studies have shown that an increased nuchal translucency (NT) may be a good marker of fetal heart malformation, but the extent to which NT is suitable for identifying the population at risk remains unclear. We aimed to determine the value of NT measurement and of the presence of cystic hygroma colli in the screening of euploid fetuses for congenital heart defects (CHD).We carried out a retrospective analysis of 12 910 euploid pregnancies examined between January 1995 and August 2007 at our institution. The screening performance of NT measurements in identifying fetuses with CHD was assessed, with comparison between the use of cut-offs defined as absolute values, multiples of the median (MoM) and percentiles. The presence of cystic hygroma colli was also assessed in the prediction of C...

Fetal interrupted aortic arch: 2D-4D echocardiography, associations and outcome

Ultrasound in Obstetrics and Gynecology — Tue, 22 Dec 2009 00:00:00 +0100

To analyze fetal two-dimensional (2D) echocardiographic characteristics of interrupted aortic arch (IAA) and its different types, to explore whether the use of 4D ultrasound with B-flow imaging and spatiotemporal image correlation (STIC) can improve prenatal diagnostic accuracy, and to describe associations and outcome.The study comprised IAA fetuses examined exclusively by 2D conventional echocardiography during the period from 1994 to 2003, and those identified by conventional echocardiography and examined further by 4D ultrasound with B-flow imaging and STIC during the period January 2004 to July 2008, identified among fetuses examined at two referral centers for congenital heart defects (CHD). Postnatal follow-up was available in all cases. Karyotyping and fluorescent in-situ hybridiza...

Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women

Ultrasound in Obstetrics and Gynecology — Tue, 22 Dec 2009 00:00:00 +0100

To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women.Stored three-dimensional (3D) volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age, 37 (range, 22-50) years) were analyzed to calculate the MGV from cyst content. Cysts with solid components or septations were excluded. MGV was calculated in all cases with the Virtual Organ Computer-aided AnaLysisTM technique. The B-mode presumptive diagnosis based on the examiner's subjective impression was also recorded.Sixteen of the cysts resolved spontaneously and were given a final clinical diagnosis of hemorrhagic functional cyst, while 38 cysts were removed surgically (diagnosed histologically a...

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

Ultrasound in Obstetrics and Gynecology — Fri, 18 Dec 2009 00:00:00 +0100

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.The database of our ultrasound laboratory was searched retrospectively for cases of hypoplasia or partial agenesis of the corpus callosum suspected at antenatal neurosonography between 1998 and 2008 and confirmed by pathology or postnatal neuroimaging. In surviving infants, clinical follow-up had been arranged to assess neurodevelopmental outcome.Nineteen fetuses with callosal underdevelopment were identified at a median gestational age of 22 (range, 21-33) weeks and confirmed at follow-up, including 14 with partial agenesis and five with hypoplasia. Among the 14 fetuses with partial agenesis, there were additional brain findings in 10, including two with absent cavum...

Profiling fetal cardiac function in twin-twin transfusion syndrome

Ultrasound in Obstetrics and Gynecology — Thu, 17 Dec 2009 00:00:00 +0100

This study aimed to provide a quantitative description of cardiac function in the recipient twin.Consecutive monochorionic pregnancies complicated with TTTS and treated by percutaneous laser coagulation underwent fetal echocardiography before surgery. An unsupervised classification analysis was conducted to identify groups of twins with similar cardiac profiles. The predictive value of the recipient twin's preoperative cardiac function based on these profiles was assessed, using perinatal death of at least one twin as the main outcome. The cardiac function profiles that we identified were compared with the current Quintero staging.A total of 107 pregnancies were included, with six of these lost to follow-up; 63/107 complete cases were available for multivariate description of the recipient...

Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group

Ultrasound in Obstetrics and Gynecology — Wed, 16 Dec 2009 00:00:00 +0100

The IETA (International Endometrial Tumor Analysis group) statement is a consensus statement on terms, definitions and measurements that may be used to describe the sonographic features of the endometrium and uterine cavity on gray-scale sonography, color flow imaging and sonohysterography. The relationship between the ultrasound features described and the presence or absence of pathology is not known. However, the IETA terms and definitions may form the basis for prospective studies to predict the risk of different endometrial pathologies based on their ultrasound appearance. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

To integrate data on the performance of cervical length measurement for the prediction of preterm birth in symptomatic women.MEDLINE, SCOPUS and manual searches for studies with transvaginal ultrasound measurement of the cervical length in symptomatic women were carried out. Random effects models were used for data integration, and pooled test estimates of sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) were calculated along with their 95% CIs.Twenty-eight studies fulfilled the selection criteria. For birth within 1 week from presentation, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 59.9% (95% CI, 52.7-66.8%), 90.5% (95% CI, 89.0-91.9%), 5.71 (95% CI, 3.77-8.65) and 0.51 (95% CI, 0.33-0.80), respectively. The same est...

Iliac crest angle: a novel sonographic parameter for the prediction of Down syndrome risk during the second trimester of pregnancy

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

To validate a new sonographic technique for the display and measurement of fetal iliac crest angle (ICA), and to determine the relative contribution of standardized fetal pelvic measurements for estimating risk of Down syndrome during the second trimester of pregnancy.Three-dimensional ultrasonography of the fetal pelvis was performed during a second-trimester scan for genetic amniocentesis. A coronal view of the 'virtual pelvis' was obtained by applying a maximum intensity projection algorithm to visualize both iliac wings. Two different ICAs were measured from a coronal projection of the fetal pelvis (ICA-coronal 1 and ICA-coronal 2); the latter approach relied on using ischial tuberosities as reference landmarks. Next, a coronal projection of the fetal pelvis was rotated to demonstrate ...

Diagnosis and management of vasa previa: a questionnaire survey

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

Our aim was to assess the current use of obstetric ultrasound imaging for the diagnosis of asymptomatic vasa previa. We also investigated obstetricians' views on the feasibility of a screening policy and their awareness of risk factors associated with this condition.A national postal survey was conducted between March and July 2006. A total of 234 questionnaires were sent to obstetric and fetomaternal consultants across England and Wales. In all, 128 questionnaires were returned, a response rate of 55%.Most respondents (85%) stated that in their hospital they do not report velamentous cord insertions at the anomaly scan. However, 73% occasionally or routinely document the presence of succenturiate lobes. Only 33% of respondents offered transvaginal scanning for the identification of vasa p...

Three-dimensional multiplanar ultrasound is a valuable tool in the study of the fetal profile in the second trimester of pregnancy

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

To evaluate the additional value of three-dimensional (3D) multiplanar ultrasound in the examination of the fetal profile.Two 3D volumes of the fetal head were obtained from 84 fetuses at 22 to 29 weeks' gestation. The volumes were taken starting at the midsagittal plane with the fetus facing the transducer. The success rate and acquisition time to obtain each volume and display the exact midsagittal plane by 3D multiplanar ultrasound were analyzed. The correction angles from the original two-dimensional (2D) profile view to the exact midsagittal plane were noted. Of six measurements, related to the fetal nose and jaws, the success rate and the intraobserver reproducibility between the 2D and the 3D multiplanar ultrasound were compared.In 81 (96.4%) cases we succeeded in obtaining a profil...

Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

This study demonstrates the feasibility of incorporating evaluation of the retronasal triangle into the routine evaluation of the fetal anatomy at 11 + 0 to 13 + 6 weeks' gestation. Because fetuses with cleft palate have an abnormal configuration of the retronasal triangle, focused examination of the midface, looking for this area at the time of the nuchal translucency scan, may facilitate the early detection of cleft palate in the first trimester. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Fetal echocardiography: z-score reference ranges for a large patient population

Ultrasound in Obstetrics and Gynecology — Tue, 15 Dec 2009 00:00:00 +0100

The main goal was to develop new z-score reference ranges for common fetal echocardiographic measurements from a large referral population.A retrospective cross-sectional study of 2735 fetuses was performed for standard biometry (biparietal diameter (BPD) and femoral diaphysis length (FDL)) and an assessment of menstrual age (MA). Standardized fetal echocardiographic measurements included aortic valve annulus and pulmonary valve annulus diameters at end-systole, right and left ventricular diameters at end-diastole, and cardiac circumference from a four-chamber view of the heart during end-diastole. Normal z-score ranges were developed for these echocardiographic measurements using MA, BPD and FDL as independent variables. This was accomplished by using first standard regression analysis an...

A case of restrictive cardiomyopathy presenting in fetal life with an isolated pericardial effusion

Ultrasound in Obstetrics and Gynecology — Wed, 09 Dec 2009 00:00:00 +0100

We describe the evolution during pregnancy of a case of restrictive cardiomyopathy which first presented at 22 weeks' gestation with a large pericardial effusion. Measurements of cardiac function were normal and remained near normal until late in the third trimester, when pulsed and tissue Doppler data suggested impairment in ventricular relaxation. This disease progressed in postnatal life to symptomatic restrictive cardiomyopathy by 2 years of age necessitating cardiac transplant. To our knowledge, this is the first time this unusual association has been reported. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Quantitative analysis of antral follicle number and size: a comparison of two-dimensional and automated three-dimensional ultrasound techniques

Ultrasound in Obstetrics and Gynecology — Wed, 09 Dec 2009 00:00:00 +0100

To compare two-dimensional (2D) ultrasound imaging with automated three-dimensional (3D) ultrasound imaging for the measurement of antral follicle number and size.Twenty-four subjects aged < 40 years underwent transvaginal ultrasound examination (Voluson E8) in the early follicular phase of the menstrual cycle. A 2D ultrasound scan of both ovaries was performed; each antral follicle was identified and then measured by taking the mean of two diameters. A 3D ultrasound dataset of both ovaries was then acquired and analyzed using Sonography-based Automated Volume Count (SonoAVCTM). The time taken to measure the size of all antral follicles in both ovaries was recorded in seconds for each technique. Antral follicle size was recorded to the nearest millimeter and counts for each 1-mm group were...

Management of women referred to an acute gynecology unit: impact of an ultrasound-based model of care

Ultrasound in Obstetrics and Gynecology — Wed, 09 Dec 2009 00:00:00 +0100

To assess the impact of the introduction of an ultrasound-based model of care for women with acute gynecological complications.This was a prospective comparative study of women attending an ultrasound-based acute gynecology unit (AGU) at the Nepean Hospital during a 6-week period 4 months after the unit's inception (new model of care), and a group of women presenting at the hospital during a similar period 6 months immediately prior to the unit's inception (traditional model). In the new model of care, ultrasound was performed at the time of the initial assessment by a senior clinician. The main outcome measures were admission rates and occupied bed days.The study included 290 consecutive women with complete data, 133 before and 157 after the introduction of the AGU. Compared with the grou...

Intravenous contrast ultrasound examination using contrast-tuned imaging (CnTITM) and the contrast medium SonoVue® for discrimination between benign and malignant adnexal masses with solid components

Ultrasound in Obstetrics and Gynecology — Thu, 19 Nov 2009 00:00:00 +0100

To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology.In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue®. Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The sensitivity and specificity with regard to malignancy were calculated and re...

Effect of progesterone on cervical shortening in women at risk for preterm birth: secondary analysis from a multinational, randomized, double-blind, placebo-controlled trial

Ultrasound in Obstetrics and Gynecology — Tue, 17 Nov 2009 00:00:00 +0100

To determine whether progesterone supplementation alters cervical shortening in women at increased risk for preterm birth.We performed a planned secondary analysis from a large, multinational preterm birth prevention trial of daily intravaginal progesterone gel, 90 mg, com- pared with placebo in women with a history of spontaneous preterm birth or premature cervical shortening. Transvaginal cervical length measurements were obtained in all randomized patients at baseline (18 + 0 to 22 + 6 weeks' gestation) and at 28 weeks' gestation. For this secondary analysis, the difference in cervical length between these time points was compared for the study population with a history of spontaneous preterm birth and for a population with premature cervical shortening ([le] 30 mm) at randomization. Di...

First-trimester fetal nasal bone audit: evaluation of a novel method of image assessment

Ultrasound in Obstetrics and Gynecology — Fri, 13 Nov 2009 00:00:00 +0100

This study has shown that clearly defined assessment criteria together with a quantitative scoring method improve the reliability of expert peer review. The quantitative method is recommended as the basis for future nasal bone image audit. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Does the size of three-dimensional power Doppler spherical sampling affect the interobserver reproducibility of measurements of vascular indices in adnexal masses?

Ultrasound in Obstetrics and Gynecology — Tue, 10 Nov 2009 00:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Three-dimensional ultrasound imaging for discrimination between benign and malignant endometrium in women with postmenopausal bleeding and sonographic endometrial thickness of at least 4.5 mm

Ultrasound in Obstetrics and Gynecology — Mon, 09 Nov 2009 00:00:00 +0100

To determine whether endometrial volume or power Doppler indices as measured by three-dimensional (3D) ultrasound imaging can discriminate between benign and malignant endometrium, to compare their diagnostic performance with that of endometrial thickness measurement using two-dimensional (2D) ultrasound examination, and to determine whether power Doppler indices add any diagnostic information to endometrial thickness or volume.Sixty-two patients with postmenopausal bleeding and endometrial thickness [ge] 4.5 mm underwent transvaginal 2D gray-scale and 3D power Doppler ultrasound examination of the corpus uteri. The endometrial volume was calculated, along with the vascularization index (VI), flow index and vascularization flow index (VFI) in the endometrium and in a 2-mm 'shell' surroundi...

Gel infusion sonography in the evaluation of the uterine cavity

Ultrasound in Obstetrics and Gynecology — Mon, 09 Nov 2009 00:00:00 +0100

To compare gel infusion sonohysterography (GIS) with saline contrast sonohysterography (SCSH) with regard to technical feasibility and procedure-related pain experienced by patients.This prospective observational cohort study included 551 consecutive patients with abnormal bleeding: SCSH was attempted in the first 402 women and GIS was attempted in the following 149. All procedures were performed by the same examiner, in the same clinical setting, using a 2-mm diameter catheter. After contrast sonohysterography, most patients underwent office hysteroscopy (n = 502) and endometrial sampling (n = 323). The women were asked to rate the pain experienced during each procedure using a 100-mm visual analog scale (VAS). Patients' characteristics, ultrasound findings, histological diagnosis, techni...

Ultrasound monitoring in patients undergoing in-vitro fertilization after methotrexate treatment for ectopic pregnancy

Ultrasound in Obstetrics and Gynecology — Mon, 09 Nov 2009 00:00:00 +0100

To compare sonographic characteristics of the endometrium and follicles during in-vitro fertilization (IVF) before and after methotrexate (MTX) treatment for ectopic pregnancy.This retrospective study, conducted at Conception Hospital from January 2000 to July 2007, included all patients diagnosed with an ectopic pregnancy resulting from IVF treatment that was treated with MTX and who then underwent another IVF cycle. We compared the number and size of follicles and the endometrial thickness and quality on the day of human chorionic gonadotropin injection in the cycles before and after the MTX treatment to determine whether MTX had any effect.Eleven patients were included in the study. The median interval between the IVF cycle resulting in ectopic pregnancy and the first IVF cycle after MT...

Sonographic identification of lower limb venous hypoplasia in the prenatal diagnosis of Klippel-Trénaunay syndrome

Ultrasound in Obstetrics and Gynecology — Mon, 09 Nov 2009 00:00:00 +0100

We report the prenatal identification of lower-limb venous hypoplasia to support a provisional prenatal diagnosis of Klippel-Trénaunay syndrome (KTS). Ultrasound assessment of a fetus with marked lower-limb edema, cystic areas in the abdomen/pelvis/lower limbs and abnormal development of the feet demonstrated bilateral hypoplasia of the femoral and popliteal veins. The external iliac veins and the great saphenous veins were seen to be normal. The lower limb arterial system was present. These findings supported KTS as the most likely provisional diagnosis, and postnatal clinical evaluation confirmed that the infant is best classified in the spectrum of KTS. Venous hypoplasia was confirmed with a postnatal ultrasound examination of the lower limbs. This case suggests that careful examinatio...

Diffusion-weighted MRI in lungs of normal fetuses and those with congenital diaphragmatic hernia

Ultrasound in Obstetrics and Gynecology — Wed, 28 Oct 2009 00:00:00 +0100

To prospectively determine apparent diffusion coefficient (ADC) values of normally developing fetal lungs over gestation, as obtained by diffusion-weighted (DW) magnetic resonance imaging (MRI) and to investigate its potential application in fetuses with congenital diaphragmatic hernia (CDH).Informed consent was obtained for this cross-sectional study of 93 fetuses with normal lungs and 14 with isolated left-sided CDH, assessed between 18 and 40 weeks of gestation. MRI delineation of left and right lungs was performed on the native DW image, b0, and three values of ADC, corresponding to the overall value (ADCavg), and values for low and high values of b (ADClow and ADChigh, respectively) were calculated. Regression analysis was used to assess the relationship between gestational age and b0...

Non-invasive fetal lung assessment using diffusion-weighted imaging

Ultrasound in Obstetrics and Gynecology — Mon, 26 Oct 2009 00:00:00 +0100

The main goal was to develop a reproducible method for estimating the diffusion of water in human fetal lung tissue using diffusion-weighted imaging (DWI). A secondary objective was to determine the relationship of the apparent diffusion coefficients (ADCs) in the fetal lung to menstrual age and total lung volume.Normal pregnant volunteers were scanned on a 1.5-Tesla (T) magnetic resonance imaging (MRI) system. The MRI system was equipped with 40-mT/m gradients (slew rate 200 T/m/s, rise time 0.2 ms). A six-channel body array coil was used for signal reception. Single-shot DWI utilized TE/TR 125/3400 ms, slice thickness 4 mm, field of view 280 mm × 280 mm, interslice gap 0.8 mm and a matrix of 128 × 128. The voxel size was 2.5 mm × 2.5 mm × 4.0 mm. Two b-values (0 and 1000) were chosen...

Giant placental chorioangioma: natural history and pregnancy outcome

Ultrasound in Obstetrics and Gynecology — Mon, 26 Oct 2009 00:00:00 +0100

Giant placental chorioangiomas are associated with a high prevalence of pregnancy complications and a poor perinatal outcome. The aim of the study was to evaluate the natural history, intrauterine treatment and outcome of pregnancies complicated by giant placental chorioangioma.This was a retrospective study of 19 cases of giant placental chorioangioma, in which the natural history, intrauterine treatment and outcome of pregnancy were evaluated.Eighteen of the 19 cases were associated with a wide variety of fetal complications, including polyhydramnios, growth restriction, hyperdynamic circulation, cardiomegaly, anemia and non-immune hydrops. Two-thirds of the cases developed complications that required either elective delivery for fetal growth restriction (n = 6) or intervention for cardi...

Dimensions of the fetal facial profile in normal pregnancy

Ultrasound in Obstetrics and Gynecology — Fri, 23 Oct 2009 23:00:00 +0100

To determine sonographic dimensions of the fetal facial profile in normal pregnancy.This was a prospective, cross-sectional study of 397 normal healthy fetuses at 14-33 weeks of gestation. After exclusion of the small numbers of patients at the upper GAs, 379 patients between 14.0 and 26.9 weeks of gestation were included in the analyses. The sagittal plane of the fetal facial profile was evaluated using transvaginal and transabdominal ultrasound. Distances from the tip of the nose to the mouth (the line between the lips), from the mouth to the gnathion (lower chin), from the upper philtrum to the mouth, and from the mouth to the upper concavity of the chin were measured and are presented according to gestational age (GA).There was a significant linear correlation between GA and the distan...

Prenatal diagnosis of brachytelephalangic chondrodysplasia punctata: case report

Ultrasound in Obstetrics and Gynecology — Thu, 22 Oct 2009 23:00:00 +0100

We report a case of brachytelephalangic chondrodysplasia punctata diagnosed by ultrasound imaging at 30 weeks' gestation; it was associated with polyhydramnios and a normal cervical spinal canal. Imaging features are described and differential diagnosis with other forms of chondrodysplasia punctata is discussed. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis

Ultrasound in Obstetrics and Gynecology — Wed, 14 Oct 2009 23:00:00 +0100

To evaluate the accuracy and the potential limitations of transvaginal sonography (TVS) in the preoperative evaluation of women with clinically suspected bladder endometriosis and to describe the sonographic features of the pathological condition in cases in which it was confirmed.In the period between 2001 and 2006, we operated on 490 patients with clinically/sonographically suspected endometriosis. In 41 cases, bladder endometriosis was diagnosed at surgery and confirmed at histopathological examination. All patients underwent TVS in a standardized manner not more than 1 month before surgery. Findings at preoperative TVS were described and compared with those at laparoscopy in order to evaluate the sensitivity, specificity, and positive and negative predictive values of TVS.Bladder endom...

Clinical application of fetal urine production rate in unexplained polyhydramnios

Ultrasound in Obstetrics and Gynecology — Tue, 13 Oct 2009 23:00:00 +0100

To evaluate the clinical use of hourly fetal urine production rate (HFUPR) in polyhydramnios.This was a retrospective review of 33 singleton pregnancies with polyhydramnios, 30 of them unexplained and three due to gastrointestinal atresia. HFUPR was estimated using three-dimensional ultrasound and was compared with recently established nomograms. Abnormal midterm outcome, defined as diagnosis or persistence of pathology after the neonatal period until the age of 2 years, was analyzed according to prenatal HFUPR measurements and other polyhydramnios characteristics.Seventeen of the 30 fetuses with unexplained polyhydramnios had an HFUPR above the 95th centile, and five (29.4%) of them developed midterm disorders. None of the 13 with normal HFUPR developed midterm disorders. The HFUPR was 1....

Does pre-eclampsia influence fetal cardiovascular function in early-onset intrauterine growth restriction?

Ultrasound in Obstetrics and Gynecology — Tue, 13 Oct 2009 23:00:00 +0100

Increasing evidence shows that intrauterine growth restriction (IUGR) is associated with fetal cardiac dysfunction. Most studies group IUGR with and without pre-eclampsia (PE) altogether. Our objective was to evaluate whether the association with PE has any impact on cardiac function in IUGR fetusesThirty-one normotensive IUGR cases and 31 IUGR cases with pre-eclampsia (PE + IUGR) below 34 weeks of gestation were included. IUGR was defined as a birth weight below the 10th centile together with an umbilical artery pulsatility index above 2 SD. Fetal cardiac function was assessed by measuring ductus venosus pulsatility index, modified myocardial performance index, aortic isthmus blood flow, E/A ratios and cardiac output. The presence of fetal cardiac dysfunction was also assessed by measurin...

Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks

Ultrasound in Obstetrics and Gynecology — Mon, 12 Oct 2009 23:00:00 +0100

To examine the performance of screening for hypertensive disorders in pregnancy at 11-13 weeks by a combination of the maternal history, uterine artery Doppler imaging and blood pressure.This was a prospective screening study for pre-eclampsia (PE) requiring delivery before 34 weeks (early PE), late PE and gestational hypertension (GH) in women attending for their routine first hospital visit in pregnancy at 11 + 0 to 13 + 6 weeks of gestation. Maternal history was recorded, color flow Doppler imaging was used to identify the uterine artery with the lowest pulsatility index (L-PI) and automated devices were used to measure the mean arterial pressure (MAP). The performance of screening for PE and GH by a combination of the maternal factor-derived a-priori risk, the uterine artery L-PI and M...

Real-time three-dimensional echocardiography using a matrix probe with live xPlane imaging of the interventricular septum

Ultrasound in Obstetrics and Gynecology — Fri, 09 Oct 2009 23:00:00 +0100

We describe live xPlane imaging, a simple method for the real-time assessment of the in-plane view of the IVS that has the potential to enhance the diagnostic accuracy of fetal cardiac examination. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Severely abnormal flow patterns in the ductus venosus in the presence of otherwise normal fetal Doppler parameters in two cases of severe intrauterine growth restriction

Ultrasound in Obstetrics and Gynecology — Thu, 08 Oct 2009 23:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Prenatal diagnosis of idiopathic infantile arterial calcification with hydrops fetalis

Ultrasound in Obstetrics and Gynecology — Wed, 07 Oct 2009 23:00:00 +0100

We describe a series of three cases in which the diagnosis of IIAC was made at 23, 25 and 29 weeks' gestation. All three cases presented with a normal anatomy scan at 20 weeks' gestation with an echogenic intracardiac focus. Follow-up scans showed generalized hyperechogenicity and calcification of the walls of the large arteries, particularly the aorta and the iliac arteries. All cases developed hydrops fetalis with cardiomegaly and polyhydramnios later in gestation, resulting in intrauterine fetal death in two cases and neonatal death immediately following delivery in the third. This is the largest case series and the earliest gestational age of prenatal diagnosis of IIAC reported to date. When surveying for the disease, serial scans are important, perhaps from 20 weeks' gestation, with c...

Anti-Ro52/SSA antibody-exposed fetuses with prolonged atrioventricular time intervals show signs of decreased cardiac performance

Ultrasound in Obstetrics and Gynecology — Thu, 01 Oct 2009 23:00:00 +0100

To investigate if anti-Ro/SSA antibody-exposed fetuses with prolonged atrioventricular (AV) time intervals also have prolongation of the isovolumetric contraction time (ICT).Seventy-eight anti-Ro/SSA (including 70 anti-Ro52) antibody-exposed fetuses at risk for congenital heart block (CHB) were followed weekly, between 18 and 24 weeks of gestation, with two Doppler echocardiographic methods designed to detect signs of first-degree AV block. One of these AV time measurements, using hemodynamic events from the mitral valve and aortic outflow as indirect markers of atrial and ventricular depolarization (MV-Ao), was also used to calculate a time interval representing an early phase of systolic cardiac performance, i.e. the ICT. Two hundred and eighty-four women with normal pregnancies served a...

Twin-reversed arterial perfusion sequence: pre- and postoperative cardiovascular findings in the 'pump' twin

Ultrasound in Obstetrics and Gynecology — Wed, 23 Sep 2009 23:00:00 +0100

To assess cardiovascular findings in twin-reversed arterial perfusion (TRAP) sequence pre- and post-therapy and compare these findings to traditional obstetric markers, defined as acardius to pump twin weight ratio and presence of polyhydramnios.This was a retrospective review of 27 cases of TRAP sequence diagnosed between 2004 and 2008. Echocardiographic data included indexed cardiac output and functional and anatomic parameters. Ultrasound reports were reviewed for acardius to pump twin weight ratio and polyhydramnios. We assessed the relationship between cardiac output and the remaining cardiac/obstetric variables obtained pre- and post-treatment.Twenty-three subjects had complete echocardiographic data sets at initial evaluation (mean gestational age, 20.4 ± 2.5 weeks) and, of these, ...

BOLD MRI in sheep fetuses: a non-invasive method for measuring changes in tissue oxygenation

Ultrasound in Obstetrics and Gynecology — Mon, 21 Sep 2009 23:00:00 +0100

The purpose of this descriptive study was to correlate changes in the blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) signal with direct measurements of fetal tissue oxygenation.Seven anesthetized ewes carrying singleton fetuses at 125 days' gestation (term 145 days) underwent BOLD MRI, covering the entire fetus in a multislice approach. The fetuses were subjected to normoxic, hypoxic and hyperoxic conditions by changing the O2/N2O ratio in the maternal ventilated gas supply. The partial pressure of oxygen (pO2) in the fetal liver was measured using an oxygen-sensitive optode. Maternal arterial blood samples were simultaneously withdrawn for blood gas analysis. These measurements were compared with BOLD MRI signals in the fetal liver, kidney, spleen and brain.We demons...

Gestational sac volume: comparison between SonoAVC and VOCAL measurements at 11 + 0 to 13 + 6 weeks of gestation

Ultrasound in Obstetrics and Gynecology — Tue, 15 Sep 2009 23:00:00 +0100

To assess the novel three-dimensional (3D) tool, Sonography-based Automated Volume CountTM (SonoAVC) in the calculation of gestational sac volume at 11 + 0 to 13 + 6 weeks of gestation, to correlate the measurements with those obtained using Virtual Organ Computed-aided AnaLysisTM (VOCAL) and to study the reproducibility of SonoAVC volume calculation of this irregularly shaped structure.We acquired 3D volumes of the uterus in 65 pregnancies at 11 + 0 to 13 + 6 weeks of gestation. We performed volume calculation of the gestational sac, excluding the fetus and the placenta, using VOCAL with 15° 12-step rotation. We then repeated the calculation with three different SonoAVC settings and compared both techniques. In 30 cases we assessed the reproducibility of the SonoAVC volume calculations.I...

Confidence of expert ultrasound operators in making a diagnosis of adnexal tumor: effect on diagnostic accuracy and interobserver agreement

Ultrasound in Obstetrics and Gynecology — Mon, 14 Sep 2009 23:00:00 +0100

To assess the degree of confidence with which expert ultrasound operators make a diagnosis of benign, borderline and invasive malignant ovarian tumors and its effect on diagnostic accuracy and interobserver agreement.Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert ultrasound operators who had not performed the original real-time ultrasound examination. The experts classified the tumors as benign, borderline or invasive malignant and they also indicated the degree of confidence with which they made the diagnosis (certain, probable and uncertain). The diagnostic accuracy and interobserver agreement, in differentiating benign, borderline and invasive malignant ...

Left ventricular cardiac function in fetuses with congenital diaphragmatic hernia and the effect of fetal endoscopic tracheal occlusion

Ultrasound in Obstetrics and Gynecology — Mon, 14 Sep 2009 23:00:00 +0100

The pre-existing compression of the left ventricle in congenital diaphragmatic hernia (CDH) could be aggravated by the amplified lung growth after fetoscopic endoluminal tracheal occlusion (FETO). Our aim was to document left ventricular (LV) size and function in fetuses with isolated left-sided CDH and to document the effect of FETO on the fetal heart.We determined cardiac axis, LV diameters, ejection fraction, shortening fraction, mitral E/A index and myocardial performance index (MPI) in 27 fetuses with isolated left-sided CDH, and compared these with values in a reference population (n = 117). In fetuses with severe CDH that subsequently underwent FETO and/or reversal of occlusion, additional measurements were obtained 24 h before and after each fetal intervention. We recorded fetal el...

Real-time fetal magnetic resonance imaging for the dynamic visualization of the pouch in esophageal atresia

Ultrasound in Obstetrics and Gynecology — Thu, 10 Sep 2009 23:00:00 +0100

We describe the application of FIESTA sequences in fetuses with suspected esophageal atresia for visualization of the esophageal pouch using MR imaging. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Use of ultrasound pattern recognition by expert operators to identify borderline ovarian tumors: a study of diagnostic performance and interobserver agreement

Ultrasound in Obstetrics and Gynecology — Wed, 09 Sep 2009 23:00:00 +0100

To assess the accuracy and reproducibility of ultrasound 'pattern recognition' for the diagnosis of borderline ovarian tumors by asking experienced ultrasound operators to evaluate representative images of different types of adnexal tumor.Digitally stored static two-dimensional B-mode images of representative cases of benign, borderline and invasive malignant ovarian tumors were independently assessed by three expert sonologists who had not performed the original real-time ultrasound examination. The outcome measures included diagnostic accuracy and interobserver agreement in the diagnosis of benign, borderline or invasive malignant ovarian tumors.One hundred and sixty-six cases were included in the final data analysis. A correct classification was made by all three experts in 83% of the p...

Laser therapy of twin-to-twin transfusion syndrome in triplet pregnancies

Ultrasound in Obstetrics and Gynecology — Wed, 09 Sep 2009 23:00:00 +0100

We report the outcome of triplet pregnancies treated with laser therapy for severe TTTS.From a database containing information on all multiple pregnancies referred to our center we identified 20 triplet pregnancies with severe TTTS. Sixteen of them were dichorionic, four monochorionic and all cases were triamniotic. Perinatal outcome was obtained in all cases.Fetoscopy was performed in 18 out of 20 cases at a median gestational age of 19.7 (range, 17.0-23.3) weeks. Delivery occurred at a median of 31.9 (range, 24.7-36.4) weeks with an overall fetal survival rate of 65%, at least one surviving fetus in 83% of cases and all three fetuses surviving in 39%.Laser coagulation is an effective treatment for severe TTTS in triplets. However, survival rates are lower than in twin pregnancies. Copyri...

Ultrasound methods to distinguish between malignant and benign adnexal masses in the hands of examiners with different levels of experience

Ultrasound in Obstetrics and Gynecology — Tue, 08 Sep 2009 23:00:00 +0100

To determine the effect of an ultrasound training course on the performance of pattern recognition when used by less experienced examiners and to compare the performance of pattern recognition, a logistic regression model and a scoring system to estimate the risk of malignancy between examiners with different levels of experience.Using ultrasound images of selected adnexal masses, two trainees classified the masses as benign or malignant by using pattern recognition both before and after they had attended a theoretical gynecological ultrasound course. They also classified the masses by using a logistic regression model and a scoring system, but only after they had attended the course. The performance of these three methods when they were used by the trainees was then compared with that whe...

Cervical length and gestational age at admission as predictors of intra-amniotic inflammation in preterm labor with intact membranes

Ultrasound in Obstetrics and Gynecology — Thu, 03 Sep 2009 23:00:00 +0100

To evaluate cervical length and gestational age as predictors of intra-amniotic inflammation in patients admitted because of preterm labor and intact membranes.Ninety-three pregnant women with preterm labor and intact membranes were included in our study. Cervical length was measured on admission by transvaginal sonography and transabdominal amniocentesis was performed within the first 48 h following admission. Positive amniotic fluid cultures defined intra-amniotic infection. Levels of intra-amniotic interleukin-6 (IL-6) were measured, and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off point of IL-6 for predicting intra-amniotic infection. This value was then used as a basis for determining a cut-off of IL-6 for defining intra-amniotic infla...

Use of Z-scores to select a fetal biometric reference curve

Ultrasound in Obstetrics and Gynecology — Thu, 03 Sep 2009 23:00:00 +0100

Fetal biometric data are a major part of prenatal ultrasound screening in the general population. The aim of this study was to analyze the effect of choice of reference curve on the quality of screening for growth abnormalities, using a statistical tool based on Z-scores.The biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were measured in 9699 ultrasound scans during the second trimester (20-24 weeks of gestation) and 8100 scans during the third trimester (30-34 weeks of gestation). These biometric data were all transformed retrospectively into Z-scores, calculated using five reference curves: those published by Snijders and Nicolaides (1994), Chitty et al. (1994), Kurmanavicius et al. (1999) and Salomon et al. (2006), and curves used ...

Fetal Doppler mechanical PR interval: correlation with fetal heart rate, gestational age and fetal sex

Ultrasound in Obstetrics and Gynecology — Wed, 02 Sep 2009 23:00:00 +0100

To establish normal fetal values for the mechanical PR interval by pulsed-wave Doppler at 16-36 weeks of gestation, and to evaluate the influence of fetal heart rate (FHR), gestational age (GA) and fetal sex.Fetal mechanical PR intervals were evaluated prospectively by obstetric ultrasound examination. Healthy mothers with sonographically normal fetuses from singleton pregnancies were included. Mechanical PR intervals were measured from simultaneous mitral and aortic Doppler waveforms, from the onset of left atrial contraction (mitral A-wave) to the onset of left ventricular ejection (aortic pulse wave). Simple and multiple linear regression analyses were performed to examine the correlation between PR interval and GA, FHR and fetal sex.We evaluated 336 fetuses at 16-36 weeks. The mean ± ...

Fetal ventricular tachycardia secondary to long QT syndrome treated with maternal intravenous magnesium: case report and review of the literature

Ultrasound in Obstetrics and Gynecology — Wed, 02 Sep 2009 23:00:00 +0100

We describe a fetus presenting at 30 weeks' gestation with ventricular tachycardia at a rate of 220 beats per min and fetal hydrops. The tachycardia was unresponsive to flecainide but was controlled within 12 h by an intravenous infusion of magnesium to the mother. Despite rapid control of the arrhythmia the fetus developed severe periventricular leukomalacia before birth for which a poor neurological prognosis was given. The baby was delivered preterm at 32 weeks' gestation and died on the sixth day after birth. Long QT syndrome was identified postnatally on the electrocardiogram, and was confirmed by genetic testing which showed a mutation in the KCNH2 gene (p.T613M). Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

New fetal weight estimation models using fractional limb volume

Ultrasound in Obstetrics and Gynecology — Tue, 01 Sep 2009 23:00:00 +0100

The main goal of this study was to determine the accuracy and precision of new fetal weight estimation models, based on fractional limb volume and conventional two-dimensional (2D) sonographic measurements during the second and third trimesters of pregnancy.A prospective cross-sectional study of 271 fetuses was performed using three-dimensional ultrasonography to extract standard measurements - biparietal diameter (BPD), abdominal circumference (AC) and femoral diaphysis length (FDL) - plus fractional arm volume (AVol) and fractional thigh volume (TVol) within 4 days of delivery. Weighted multiple linear regression analysis was used to develop 'modified Hadlock' models and new models using transformed predictors that included soft tissue parameters for estimating birth weight. Estimated an...

In-utero stenting: development of a low-cost high-fidelity task trainer

Ultrasound in Obstetrics and Gynecology — Mon, 31 Aug 2009 23:00:00 +0100

To develop an in-utero stent placement training model.The in-utero stent task trainer was constructed using a formalin-preserved gravid pig uterus. Altering the size of the uterine segment, changing the fluid level in the uterus and addition of a large Ziploc freezer bag variably filled with differing amounts of ultrasound gel can vary the procedural skill required.Thoracoamniotic and vesicoamniotic shunts can be simulated using this life-like model. The cost of eight to 10 learning stations is approximately US $ 60. Fetal position, maternal size and amniotic fluid status can be altered rapidly to increase the complexity of the procedure.This low-cost and realistic task trainer can provide the opportunity to practice in-utero shunt procedures in a non-clinical environment. This model shoul...

"Retracted: Changes in the Tei index during acute fetal hypoxemia in the near-term ovine fetus after intermittent umbilical cord occlusion"

Ultrasound in Obstetrics and Gynecology — Fri, 21 Aug 2009 23:00:00 +0100

Retraction: The following article from Ultrasound in Obstetrics and Gynecology, Changes in the Tei index during acute fetal hypoxemia in the near-term ovine fetus after intermittent umbilical cord occlusion by G. Lu, Z. Wang, S. He, B. Li, Z. Huang, Q. Chen, P. Jin, R. Su, published online on July 18 2007 in Wiley InterScience (), has been retracted by agreement between the journal Editor- in-Chief, Yves Ville and John Wiley and Sons, Ltd. The retraction has been agreed because the article shows significant overlap with another paper published by the group in Prenatal Diagnosis, entitled "Tei index for prenatal diagnosis of acute fetal hypoxia due to intermittent umbilical cord occlusion in an animal model" (Prenat Diagn 2007; 27: 817-823). Copyright © 2009 ISUOG. Published by John Wiley ...

Bilateral cleft lip and palate without premaxillary protrusion is associated with lethal aneuploidies

Ultrasound in Obstetrics and Gynecology — Thu, 20 Aug 2009 23:00:00 +0100

To investigate the clinical implications of two categories of fetal bilateral cleft lip and palate (BCLP): with premaxillary protrusion and with a flattened profile.This was a retrospective study of fetuses with a prenatal diagnosis of BCLP at the Department of Obstetrics and Gynecology of the University of Bologna in the period 1991-2005.BCLP was diagnosed prenatally in 14 cases (mean gestational age at diagnosis, 21 (range, 12-36) weeks). In nine of these, there was a premaxillary pseudomass; in the remaining five, the profile was flat. Associated structural and/or chromosomal anomalies were found in two of the nine with a premaxillary pseudomass and in all five of those with a flat profile (P = 0.02). All fetuses with a flat profile had aneuploidies (three trisomy 18, one trisomy 13, on...

Diagnostic performance of routine ultrasound screening for fetal abnormalities in an unselected Swedish population in 2000-2005

Ultrasound in Obstetrics and Gynecology — Mon, 17 Aug 2009 23:00:00 +0100

To determine the detection rate of fetal malformations and chromosomal abnormalities and the rate of false-positive ultrasound diagnoses at routine ultrasound examinations carried out by specially trained midwives in an unselected pregnant population from 2000 to 2005, and to describe the consequences of true-positive and false-positive ultrasound diagnoses of fetal malformations.A retrospective analysis was undertaken of all babies born in Malmö, Sweden, between January 2000 and December 2005 by mothers residing in Malmö and of all fetuses with an ultrasound diagnosis of malformation made in the same time interval at the two units performing all routine pregnancy scans in Malmö. All women underwent two routine scans, at 18 and 32 weeks, including scrutiny of the fetal anatomy. Detectio...

Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses

Ultrasound in Obstetrics and Gynecology — Sun, 16 Aug 2009 23:00:00 +0100

To determine the sensitivity and specificity of subjective evaluation of gray-scale and Doppler ultrasound findings (here called pattern recognition) when used by experienced ultrasound examiners with regard to making a specific diagnosis of adnexal masses.Within the framework of a European multicenter study, the International Ovarian Tumor Analysis study, comprising nine ultrasound centers, women with at least one adnexal mass were examined with gray-scale and color Doppler ultrasonography by experienced ultrasound examiners. A standardized examination technique, and standardized terms and definitions were used. Using pattern recognition the examiners classified each mass as benign or malignant and suggested a specific diagnosis (e.g. dermoid cyst or endometrioma). The reference standard ...

Single-needle laser treatment with drainage of hydrothorax in fetal bronchopulmonary sequestration with hydrops

Ultrasound in Obstetrics and Gynecology — Thu, 13 Aug 2009 23:00:00 +0100

Endometrial blood flow is impaired in women with polycystic ovarian syndrome who are clinically hyperandrogenic

Ultrasound in Obstetrics and Gynecology — Tue, 11 Aug 2009 23:00:00 +0100

To quantify endometrial and subendometrial blood flow in Caucasian women with polycystic ovarian syndrome (PCOS) and to determine whether these values differ according to the phenotypic expression of PCOS.Transvaginal pelvic ultrasound was performed on the 3rd-5th day of the menstrual cycle in 36 women with PCOS and 36 controls to examine the endometrial and subendometrial vascularity. The subendometrial and endometrial blood flow indices (vascularizaton index (VI), flow index (FI) and vascularization flow index (VFI)) were measured using three-dimensional power Doppler angiography. Uterine artery blood flow was assessed through analysis of two-dimensional (2D) pulsed-wave Doppler waveforms. Analysis was performed to compare PCOS with non-PCOS women, and subgroup analysis was performed of ...

Placental size and the prediction of severe early-onset intrauterine growth restriction in women with low pregnancy-associated plasma protein-A

Ultrasound in Obstetrics and Gynecology — Mon, 10 Aug 2009 23:00:00 +0100

Screening studies for trisomy 21 demonstrate that low maternal serum pregnancy-associated plasma protein-A (PAPP-A) at 11-13 weeks' gestation is associated with stillbirth, intrauterine growth restriction (IUGR) and pre-eclampsia in chromosomally normal fetuses. However, the strength of these associations is too weak to justify screening for these placental insufficiency syndromes. Our objective was to evaluate placental size and uterine artery (UtA) Doppler imaging as second-stage screening tests for women with low PAPP-A.We prospectively studied 90 normal singleton pregnancies with first-trimester PAPP-A [le] 0.30 multiples of the median. Maternal serum [alpha]-fetoprotein (AFP) at 15-18 weeks' gestation, and second-trimester placental size and UtA Doppler indices were assessed as predic...

Re: use of serum progesterone measurements to reduce need for follow-up in women with pregnancies of unknown location

Ultrasound in Obstetrics and Gynecology — Mon, 10 Aug 2009 23:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Role of prenatal ultrasound in predicting survival and mental and motor functioning in children with spina bifida

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

To determine which prenatal ultrasound findings can predict survival and mental and motor functioning in children with spina bifida.Prenatal ultrasound examinations of all liveborn children who were prenatally diagnosed with spina bifida between 1997 and 2002 at the University Medical Centre, Utrecht (n = 41) were retrospectively reviewed for lesion level, head circumference, ventriculomegaly, scoliosis and talipes. These measures were correlated with postnatal anatomical (as assessed by magnetic resonance imaging (MRI)) and functional lesion levels, survival and motor and mental outcome at 5 years of age. The capacity of prenatal ultrasonography to determine lesion level was also assessed in all fetuses diagnosed with spina bifida from 2006-2007 (n = 18).Nineteen infants died before the a...

Reply

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

A question of angle of view

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Which ultrasound or biochemical markers are independent predictors of small-for-gestational age?

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

To investigate which ultrasound or biochemical markers in both the first and the second trimesters are the best predictors for fetal growth and small-for-gestational age (SGA).This was a prospective study of 619 Chinese women with a singleton pregnancy. At 11 to 13 + 6 weeks, fetal crown-rump length (CRL), placental volume (PlaV), uterine artery pulsatility index (UtA-PI), and the maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free [beta]-human chorionic gonadotropin ([beta]-hCG) were measured. Fetal biparietal diameter, femur length, abdominal and head circumference, PlaV and UtA-PI were then measured at 18-22 weeks. All markers were transformed to gestational age-specific Z-scores or multiples of the median (MoM). Birth weights were also transformed to Z-scor...

Validation of models that predict Cesarean section after induction of labor

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

The objective of this study was to validate two existing models, published by Peregrine et al. and Rane et al., for the prediction of Cesarean section after induction of labor.We studied consecutive women in whom labor was induced. In all women, we recorded maternal age, height, body mass index, parity, gestational age and the Bishop score prior to induction. Cervical length was measured by transvaginal ultrasound immediately prior to induction of labor. The primary end-point was delivery by Cesarean section. The calibration of the two prediction models was assessed by comparison of predicted and observed Cesarean delivery rates. The discriminative capacity of the models, i.e. the ability of the models to distinguish subjects who had Cesarean section from those who did not (discrimination)...

Are ultrasonographic myoma characteristics associated with blood loss at delivery?

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

The presence of myomas in pregnancy is associated with greater blood loss at delivery. The aim of this study was to evaluate whether the sonographic characteristics of myomas can predict blood loss at delivery in women with large myomas.Among women who underwent second-trimester ultrasound screening at our department between January 1996 and December 2004, 251 had at least one myoma with a mean diameter [ge] 5 cm. Number of myomas (single vs. multiple), maximum diameter of the largest myoma, sum of the maximum diameter of each myoma, change in size of myomas between first and last scan, and location in relation to the placenta and to the presenting part of the fetus (above or below) were analyzed in relation to blood loss at delivery and severe postpartum hemorrhage ([ge] 1000 mL).Multivar...

Reply

Ultrasound in Obstetrics and Gynecology — Sun, 09 Aug 2009 23:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion

Ultrasound in Obstetrics and Gynecology — Tue, 04 Aug 2009 23:00:00 +0100

To examine operative and perinatal aspects of fetal endoscopic tracheal occlusion (FETO) in congenital diaphragmatic hernia (CDH).This was a multicenter study of singleton pregnancies with CDH treated by FETO. The entry criteria for FETO were severe CDH on the basis of sonographic evidence of intrathoracic herniation of the liver and low lung area to head circumference ratio (LHR) defined as the observed to the expected normal mean for gestation (o/e LHR) equivalent to an LHR of 1 or less.FETO was carried out in 210 cases, including 175 cases with left-sided, 34 right-sided and one with bilateral CDH. In 188 cases the CDH was isolated and in 22 there was an associated defect. FETO was performed at a median gestational age of 27.1 (range, 23.0-33.3) weeks. The first eight cases were done un...

Keyhole sign: how specific is it for the diagnosis of posterior urethral valves?

Ultrasound in Obstetrics and Gynecology — Wed, 29 Jul 2009 23:00:00 +0100

Posterior urethral valves (PUV) are the most common cause of renal impairment in boys during early childhood. Although antenatal suspicion of this pathology has become quite common in recent years, prenatal diagnosis remains challenging. The aim of this study was to evaluate the predictive value of different ultrasound criteria currently used to diagnose PUV.We reviewed the antenatal and postnatal files of 54 male patients referred to our center from 2000 to 2006 after detection of fetal bilateral hydronephrosis. The following ultrasound criteria were evaluated in relation to the postnatal diagnosis of PUV: amniotic fluid volume, bladder wall thickness, bladder dilatation and the presence of the 'keyhole sign'.Forty-two fetuses (77.8%) were suspected to have PUV on prenatal examination. Ou...

Virtual reality ultrasound imaging of the normal and abnormal fetal central nervous system

Ultrasound in Obstetrics and Gynecology — Fri, 24 Jul 2009 23:00:00 +0100

In fetal ultrasound imaging, teaching and experience are of paramount importance to improve prenatal detection rates of fetal abnormalities. Yet both aspects depend on exposure to normal and, in particular, abnormal 'specimens'. We aimed to generate a number of simple virtual reality (VR) objects of the fetal central nervous system for use as educational tools.We applied a recently proposed algorithm for the generation of fetal VR object movies to the normal and abnormal fetal brain and spine. Interactive VR object movies were generated from ultrasound volume data from normal fetuses and fetuses with typical brain or spine anomalies. Pathognomonic still images from all object movies were selected and annotated to enable recognition of these features in the object movies.Forty-six virtual r...

Male gender as a favorable prognostic factor in pregnancies with enlarged nuchal translucency

Ultrasound in Obstetrics and Gynecology — Sat, 18 Jul 2009 23:00:00 +0100

The aim of this study was to investigate the influence of fetal gender on pregnancy outcome in fetuses with enlarged nuchal translucency (NT).Pregnancy outcomes of all women who underwent an NT measurement at our institution between January 2000 and November 2007 were retrospectively reviewed. Separate analyses were performed for fetuses with normal and with enlarged ([ge] 95th percentile) NT.A normal NT was measured in 3637 males (51.4%) and 3435 females (48.6%). Of the fetuses with enlarged NT 365 were males (57.4%) and 271 females (42.6%) (P = 0.001). In this group a normal pregnancy outcome - of those pregnancies for which the outcome was known - was registered for 187/332 (56.3%) of the male fetuses and 98/249 (39.4%) of the female fetuses (P < 0.001; relative risk (RR) for adverse ou...

Effect of mifepristone on the corpus luteum in early pregnancy

Ultrasound in Obstetrics and Gynecology — Thu, 16 Jul 2009 23:00:00 +0100

The antiprogestin mifepristone is widely used for medical termination of pregnancy (TOP). Previous studies have suggested that the mechanism of mifepristone is based on its action in the endometrium and myometrium. The aim of this study was to evaluate the possible effects of mifepristone on corpus luteum activity.This was a prospective, longitudinal controlled study to which 20 patients undergoing medical TOP (study group) and 20 patients with normal ongoing pregnancy (control group) were recruited. Medical TOP was induced with 200 mg of mifepristone followed by 0.8 mg of misoprostol 2 days later. Three-dimensional ultrasound examinations and hormone assays (progesterone, human chorionic gonadotropin, and 17-hydroxyprogesterone) were performed in both groups on the day of, and 2 days afte...

Agreement between umbilical vein volume blood flow measurements obtained at the intra-abdominal portion and free loop of the umbilical cord

Ultrasound in Obstetrics and Gynecology — Tue, 14 Jul 2009 23:00:00 +0100

The umbilical vein (UV) is a single vessel and theoretically the volume of blood flowing through it should be equal whether it is measured at the intra-abdominal portion (IA) or a free loop of the umbilical cord (FL). However, the reported values vary considerably depending on the technique and site of measurement. Our objective was to investigate the correlation and agreement between UV volume blood flows (Quv) measured at the IA and FL.Blood flow velocities and inner diameter of the UV were measured cross-sectionally at the IA and FL in 131 pregnant women at 22-24 weeks' gestation, and in 53 of them longitudinally at 4-weekly intervals until delivery. For each sampling site, the Quv was calculated as: 0.5 × time-averaged maximum velocity × [pi] × (UV diameter/2)2.The mean Quv measured...

Prenatal diagnosis of cardiac rhabdomyomas: incidence of associated cerebral lesions of tuberous sclerosis complex

Ultrasound in Obstetrics and Gynecology — Tue, 14 Jul 2009 23:00:00 +0100

To determine the prevalence of specific cerebral lesions of tuberous sclerosis complex (TSC) and neurological outcome in cases diagnosed prenatally with cardiac rhabdomyomas.We reviewed all fetuses diagnosed prenatally with cardiac rhabdomyomas which had undergone detailed ultrasound evaluation and cerebral magnetic resonance imaging (MRI) and which were recorded in the database of a single institution covering the period January 1992 to December 2005.Fifty-one fetuses were included in the study. MRI was performed at a mean ± SD gestational age of 30 ± 3 gestational weeks and showed specific lesions of TSC in 49% of cases. Termination of pregnancy was chosen by the parents in 26 cases. Neurological development was studied in 20 cases, follow-up lasting 4.8 ± 2.9 years. Neurodevelopmenta...

Doppler and gray-scale sonographic classification of adnexal torsion

Ultrasound in Obstetrics and Gynecology — Tue, 14 Jul 2009 23:00:00 +0100

To propose, in cases with coiling of the ovarian vessels, a classification of severity of torsion based on Doppler and gray-scale ultrasound findings and to suggest a treatment strategy for each situation.Seventeen patients were examined in a gynecological emergency room between December 1995 and February 2003 due to suspected adnexal torsion. Doppler and gray-scale ultrasound were used to visualize coiling of the ovarian blood vessels. Intraovarian flow was assessed by spectral Doppler and on this basis, along with the patient's clinical condition, the decision was made as to whether surgery was necessary. Findings on surgery were recorded.All 17 patients showed coiling of the ovarian vessels. Nine had arterial and venous blood flow within the ovary and ultrasound and surgical findings us...

Use of ultrasound biomicroscopy to image human ovaries in vitro

Ultrasound in Obstetrics and Gynecology — Tue, 14 Jul 2009 23:00:00 +0100

To test the hypothesis that ultrasound biomicroscopy is an effective tool for imaging human ovaries in vitro.This was a prospective, observational study of 11 women (mean age, 48.9 ± 2.3 years; range, 40-65 years) undergoing unilateral or bilateral oophorectomy. Ovaries were obtained in the operating room and imaged in a cooled saline bath using conventional two-dimensional (2D) ultrasound. Follicles identified using conventional 2D ultrasound were then imaged in a cooled saline bath using ultrasound biomicroscopy. Ovaries were then placed in 10% neutral-buffered formaldehyde and transported to the Pathology Department for histological evaluation. Digital images of individually identified ovarian follicles using conventional ultrasound, ultrasound biomicroscopy and histology were obtained...

Prenatal magnetic resonance imaging: towards optimized patient information

Ultrasound in Obstetrics and Gynecology — Mon, 13 Jul 2009 23:00:00 +0100

To investigate the perception of fetal magnetic resonance imaging (MRI) by women confronted with the necessity of a targeted prenatal examination because of suspicion of an abnormality, in order to develop a pre-scan information leaflet tailored to the information requirements of these women.Sixty-two women were assessed by qualitative interview immediately before and after scanning. Data were analyzed by means of a qualitative content analysis. The transcribed interviews were coded within established categories, including knowledge of the purpose of the exam, understanding of the procedure, expectation of the baby's reaction, satisfaction with pre-information, experience of fetal MRI, distressing conditions during scanning, anxiety and suggestions for improvement of the scanning procedure...

Pulsations in the umbilical vein during labor are associated with increased risk of operative delivery for fetal distress

Ultrasound in Obstetrics and Gynecology — Tue, 07 Jul 2009 23:00:00 +0100

Under physiological conditions the blood flow velocity waveform in the umbilical vein (UV) has an even non-pulsating pattern. Pulsations in the UV have been described in human fetuses exposed to chronic hypoxia and heart failure. Current techniques for fetal surveillance during labor and delivery involve a risk of both over- and underestimation of fetal hypoxia. We aimed to examine whether pulsations in the UV appear in the human fetus during suspected intrapartum hypoxia, and if so whether they are associated with increased risk of operative delivery for fetal distress (ODFD).This was a prospective double blind study including 52 normal pregnancies. A Doppler examination of the UV was performed on 26 fetuses with pathological and 26 fetuses with normal cardiotocography (CTG) during labor....

Adding a single CA 125 measurement to ultrasound imaging performed by an experienced examiner does not improve preoperative discrimination between benign and malignant adnexal masses

Ultrasound in Obstetrics and Gynecology — Tue, 07 Jul 2009 23:00:00 +0100

To determine whether CA 125 measurement is superior to ultrasound imaging performed by an experienced examiner for discriminating between benign and malignant adnexal lesions, and to determine whether adding CA 125 to ultrasound examination improves diagnostic performance.This is a prospective multicenter study (International Ovarian Tumor Analysis (IOTA) study) conducted in nine European ultrasound centers in university hospitals. Of 1149 patients with an adnexal mass examined in the IOTA study, 83 were excluded. Of the remaining 1066 patients, 809 had CA 125 results available and were included. The patients underwent preoperative serum CA 125 measurements and transvaginal ultrasound examination by an experienced ultrasound examiner blinded to CA 125 values. The examiner classified each m...

Comparison of fundal height measurement and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight at term

Ultrasound in Obstetrics and Gynecology — Mon, 06 Jul 2009 23:00:00 +0100

In this study we included 7138 low-risk women from that population who underwent fundal height measurements no more than 8 days before delivery (Population A). We also included another 1689 women with both fundal height measurements and fetal ultrasound measurements obtained no more than 8 days before delivery (Population B). Population A was used to calculate the parameters of equations for estimating fetal weight according to fundal height alone (EFWFH) or fundal height in combination with other clinical indicators (EFWFH+). The ultrasound fetal weight estimation was based on fetal abdominal circumference (EFWAC) using Campbell and Wilkins' equation. The correlation between the estimated fetal weight calculated using each of the formulae and the birth weight was then evaluated in Populat...

Relationship of intertwin crown-rump length discrepancy to chorionicity, fetal demise and birth-weight discordance

Ultrasound in Obstetrics and Gynecology — Thu, 25 Jun 2009 23:00:00 +0100

To study the frequency and clinical significance of crown-rump length (CRL) discrepancy at 11-14 weeks of gestation in twin pregnancies from an unselected population.This was a retrospective analysis of all twin pregnancies that underwent a routine 11-14-week scan at a large teaching hospital. Fetal loss was defined as fetal demise of one or both twins after 14 weeks.A total of 507 twin pregnancies were studied; 382 (75.3%) were dichorionic and 125 (24.7%) were monochorionic twins. The discrepancy in CRL was expressed as a percentage of the CRL of the larger twin. The 95th and 99th centile for CRL discrepancy in twins was 12.2% and 19.3%, respectively. The discrepancy in CRLs in monochorionic and dichorionic twins was not significantly different (Mann-Whitney U = 22 406, P = 0.302). In 39 ...

Quality of nuchal translucency measurements in The Netherlands: a quantitative analysis

Ultrasound in Obstetrics and Gynecology — Thu, 25 Jun 2009 23:00:00 +0100

The Dutch Centre for Population Research has specified quality demands for nuchal translucency (NT) measurement in The Netherlands. We performed an analysis of the quality of NT measurement in 2005-2006 and its influence on screening performance.This was a retrospective study of records of NT measurements (n = 27 738) obtained between January 2005 and December 2006 retrieved from the Dutch National Institute for Public Health and the Environment (RIVM). The performance of each individual operator was analyzed with regard to the quality standards, which involved calculation of operator-specific median NT-multiples of the median (MoM) values. For the entire population of operators, a curve was determined describing the relationship between crown-rump length and NT. Detection rates (DR) and f...

Prenatal sonographic diagnosis of skeletal dysplasias

Ultrasound in Obstetrics and Gynecology — Wed, 24 Jun 2009 23:00:00 +0100

To assess the types and numbers of cases, gestational age at specific prenatal diagnosis and diagnostic accuracy of the diagnosis of skeletal dysplasias in a prenatal population from a single tertiary center.This was a retrospective database review of type, prenatal and definitive postnatal diagnoses and gestational age at specific prenatal diagnosis of all cases of skeletal dysplasias from a mixed referral and screening population between 1985 and 2007. Prenatal diagnoses were grouped into 'correct ultrasound diagnosis' (complete concordance with postnatal pediatric or pathological findings) or 'partially correct ultrasound diagnosis' (skeletal dysplasias found postnatally to be a different one from that diagnosed prenatally).We included 178 fetuses in this study, of which 176 had a prena...

Prospective validation of first-trimester combined screening for trisomy 21

Ultrasound in Obstetrics and Gynecology — Wed, 17 Jun 2009 04:00:00 +0100

This study has validated the new risk algorithm and demonstrated that in combined screening for trisomy 21 based on maternal age, fetal NT and free [beta]-hCG and PAPP-A the detection rate is about 90% for a 3% false-positive rate. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary

Ultrasound in Obstetrics and Gynecology — Mon, 15 Jun 2009 04:00:00 +0100

To describe the clinical and ultrasound features of fibroma and fibrothecoma of the ovary.Sixty-eight women with a histological diagnosis of fibroma or fibrothecoma of the ovary who had undergone a preoperative ultrasound examination between 1999 and 2007 were identified from the databases of four ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In 51 patients, ultrasound information had been collected prospectively; in the remaining 17 cases it was retrieved retrospectively from ultrasound reports and images. In 44 cases, electronic ultrasound images of good quality were available. These were reviewed by t...

Diagnosis in the first trimester of placenta accreta with previous Cesarean section

Ultrasound in Obstetrics and Gynecology — Thu, 11 Jun 2009 04:00:00 +0100

The prenatal diagnosis of adherent placenta is clinically very important, as this condition can seriously affect perinatal mortality and morbidity. The outcome is generally worse in cases with a history of Cesarean section. Here we report a case of placenta increta associated with previous Cesarean delivery, diagnosed by sonography during the first trimester, enabling earlier counseling of the parents and planning of appropriate treatment. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

Twin growth discrepancy in early pregnancy

Ultrasound in Obstetrics and Gynecology — Thu, 11 Jun 2009 04:00:00 +0100

To assess whether early fetal growth restriction in a twin, expressed as the intertwin discrepancy in crown-rump length (CRL) between two viable twins at 7 + 0 to 9 + 6 weeks' gestation, is predictive of subsequent single fetal loss.This was a retrospective analysis of data collected prospectively over 3 years. Women attending an early pregnancy unit underwent a transvaginal ultrasound examination. In women with a viable twin pregnancy between 7 + 0 and 9 + 6 weeks of gestation, the CRL ratio between the two embryos was calculated. Women were followed up and the intertwin discrepancy in CRL at the 7 + 0 to 9 + 6-week scan was compared between cases in which there was spontaneous reduction to a singleton and those in which both twins remained viable at the 11-14-week scan.There were 77 wome...

Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention

Ultrasound in Obstetrics and Gynecology — Wed, 10 Jun 2009 04:00:00 +0100

To evaluate the ability of endometrial thickness after medical abortion to predict the need for subsequent dilatation and curettage (D&C).We pooled data from two multicenter medical abortion trials involving 2208 women who received mifepristone orally followed by misoprostol vaginally. Women returned for transvaginal ultrasonography approximately 7 days later. The endometrial thickness was measured if no gestational sac was present. Final status was confirmed by a phone interview at 5 weeks. The area under the receiver-operating characteristics (ROC) curve was calculated to assess the overall ability of endometrial thickness to predict the need for subsequent D&C. Endometrial thickness was dichotomized using threshold values at 5-mm increments from 10 to 30 mm. The sensitivity, specificity...

Measurement error for ultrasound fetal biometry performed by paramedics in rural Bangladesh

Ultrasound in Obstetrics and Gynecology — Tue, 09 Jun 2009 04:00:00 +0100

To document the accuracy and precision of sonographic fetal biometry performed by nine paramedics from rural Bangladesh.Paramedics underwent intensive training (6 weeks) including hands-on practice then underwent a series of standardization exercises. Measurements of each fetus were taken by a highly-trained medical doctor (study supervisor) and the nine paramedics. Crown-rump length (CRL) in fetuses of less than 10 weeks' gestation, and biparietal diameter (BPD), occipitofrontal diameter, head and abdominal circumference (AC) and femur diaphysis length (FL) were measured twice using standard procedures by each paramedic and the medical doctor for each fetus, with at least 20 min between them. Precision was quantified using variance components analysis; the intraobserver error for each of ...

Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study

Ultrasound in Obstetrics and Gynecology — Fri, 05 Jun 2009 04:00:00 +0100

To assess the fetal loss rate following amniocentesis and chorionic villus sampling (CVS).This was a national registry-based cohort study, including all singleton pregnant women who had an amniocentesis (n = 32 852) or CVS (n = 31 355) in Denmark between 1996 and 2006. Personal registration numbers of women having had an amniocentesis or a CVS were retrieved from the Danish Central Cytogenetic Registry, and cross-linked with the National Registry of Patients to determine the outcome of each pregnancy. Postprocedural fetal loss rate was defined as miscarriage or intrauterine demise before 24 weeks of gestation.The miscarriage rates were 1.4% (95% CI, 1.3-1.5) after amniocentesis and 1.9% (95% CI, 1.7-2.0) after CVS. The postprocedural loss rate for both procedures did not change during the ...

High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination

Ultrasound in Obstetrics and Gynecology — Fri, 05 Jun 2009 04:00:00 +0100

To determine the ability to correctly identify Cesarean section scars, to estimate the prevalence of defective scars, and to determine the size and location of scar defects by transvaginal ultrasound imaging.Two hundred and eighty-seven women underwent transvaginal ultrasound examination 6-9 months after delivery: 108 had undergone one Cesarean section, 43 had had two Cesarean sections, 11 had undergone at least three Cesarean sections, and 125 were primiparae who had delivered vaginally. The ultrasound examiner was blinded to the obstetric history until all scans had been evaluated.None of the 125 vaginally delivered women had a visible scar in the uterus, whereas all women who had undergone Cesarean section had at least one visible scar. Median myometrial thickness at the level of the is...

Intrauterine sonographic measurement of the embryonic brain mantle

Ultrasound in Obstetrics and Gynecology — Mon, 01 Jun 2009 04:00:00 +0100

To evaluate embryonic brain mantle measurements using intrauterine sonography in the early first trimester.In 85 women about to undergo therapeutic termination at 6-11 weeks' gestation we studied the embryonic brain mantle using a specially developed 20-MHz, flexible, catheter-based, high-resolution, real-time, miniature (1.8 mm in outer diameter) ultrasound transducer. Thickness of the embryonic brain telencephalon, diencephalon, mesencephalon and rhombencephalon was measured.We found a linear relationship between gestational age and telencephalon thickness (R2 = 51.9%, P < 0.0001), diencephalon thickness (R2 = 62.2%, P < 0.0001), mesencephalon thickness (R2 = 59.2%, P < 0.0001) and rhombencephalon thickness (R2 = 47.8%, P = 0.0043). There was also a linear relationship between crown-rump...

Computerized analysis of normal fetal heart rate pattern throughout gestation

Ultrasound in Obstetrics and Gynecology — Mon, 01 Jun 2009 04:00:00 +0100

To analyze the evolution of computerized cardiotocography (cCTG) parameters throughout gestation in a large archive of traces from healthy fetuses.This was a cross-sectional study of the first cCTG record from 4412 singleton fetuses with good pregnancy outcome. Normal ranges of cCTG parameters for 25 to 42 weeks were derived from analysis of only one cCTG record per fetus, and the relationship between the parameters and gestational age was investigated.Fetal heart rate (FHR) accelerations, short- and long-term variation overall, duration of episodes of high and low variation and variation in high episodes increased with advancing gestation. In contrast, maternal perception of fetal movements, basal FHR, variation in low episodes and the time until criteria for normality were met decreased ...

Is the non-respect of ethical principles by health professionals during first-trimester sonographic Down syndrome screening damaging to patient autonomy?

Ultrasound in Obstetrics and Gynecology — Mon, 01 Jun 2009 04:00:00 +0100

To evaluate the understanding of health professionals involved in first-trimester ultrasound screening of the ethical stakes involved by addressing three questions regarding: how much these professionals know about Down syndrome screening by nuchal translucency thickness measurement; their personal opinion with respect to this screening test; and their attitude with respect to their patients, in order to answer the question: 'Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?'.We studied the medical population in the east part of France by sending a questionnaire to each of 460 medical correspondents. This questionnaire attempted to evaluate the respondent's level of medical knowledge, their personal opinion with respect t...

Systolic myocardial velocity alterations in the growth-restricted fetus with cerebroplacental redistribution

Ultrasound in Obstetrics and Gynecology — Mon, 01 Jun 2009 04:00:00 +0100

Intrauterine growth restriction (IUGR) is associated with cerebroplacental redistribution (CPR), fetal stress and poor outcome, all of which may be related to dysfunction of the fetal myocardium. The aim of this study was to specifically assess myocardial function in IUGR fetuses with CPR in comparison with normal fetuses using color Doppler myocardial imaging (CDMI).CDMI was used to evaluate and compare myocardial velocities in the left and right ventricles in normal fetuses and in IUGR fetuses with CPR. Peak systolic tissue velocities (S[prime]) were acquired from both ventricular free walls in 20 IUGR fetuses (gestational age at scan ranged from 26 + 1 to 34 + 6 weeks, with serial measurements obtained in nine) and 42 normal fetuses (35 at week 28, with the remaining seven undergoing se...

Thick fetal corpus callosum: an ominous sign?

Ultrasound in Obstetrics and Gynecology — Fri, 15 May 2009 04:00:00 +0100

Anomalies of the corpus callosum are frequently diagnosed during pregnancy, but a thick corpus callosum is a rare finding and its significance is not clear. We aimed to assess the significance of thick fetal corpus callosum by reviewing our experience of such cases.The records of all fetuses with anomalies of the corpus callosum referred to the prenatal diagnosis units of two university hospitals from 2000 to 2007 were reviewed. Nine fetuses with a thick corpus callosum were identified.In all cases there were associated abnormalities: macrocephaly, ventriculomegaly, vermian agenesis, abnormal sulcation or encephalocele. Four pregnancies were terminated and in each of these cases the autopsy confirmed dysmorphic features and additional brain abnormalities. Five infants were delivered; two d...

Can prenatal ultrasound detect the effects of in-utero alcohol exposure? A pilot study

Ultrasound in Obstetrics and Gynecology — Thu, 14 May 2009 04:00:00 +0100

The aim of this pilot study was to explore possible ultrasound parameters for the early detection of alcohol-mediated fetal somatic and central nervous system (CNS) maldevelopment. Maternal alcohol ingestion during pregnancy may lead to fetal alcohol spectrum disorders (FASD), which encompass a broad range of structural abnormalities including growth impairment, specific craniofacial features and CNS abnormalities. Early detection of fetuses at risk of FASD would support earlier interventions.We performed a longitudinal prospective pilot study from 2004 to 2006 at two sites in Ukraine. A sample of pregnant women who reported consuming moderate-to-heavy amounts of alcohol participated in a comprehensive maternal interview, and received ultrasound evaluation of fetal growth and specific feta...

Use of serum progesterone measurements to reduce need for follow-up in women with pregnancies of unknown location

Ultrasound in Obstetrics and Gynecology — Thu, 14 May 2009 04:00:00 +0100

To assess the efficacy of a progesterone-based algorithm for the management of women with pregnancies of unknown location (PULs) and explore the feasibility of developing a single-visit strategy in those with a low risk of requiring medical intervention.All clinically stable women in whom pregnancy could not be identified on ultrasound scan were managed by a pre-defined protocol based on measurement of serum progesterone and [beta]-human chorionic gonadotropin ([beta]-hCG). Intervention in the form of surgery or medical treatment with methotrexate was offered to all women with persistent or worsening symptoms and non-declining serum [beta]-hCG. Decision-tree analysis was used to develop a protocol for the management of women with resolving pregnancies who are at low risk of requiring medic...

Does tubal ectopic pregnancy with hemoperitoneum always require surgery?

Ultrasound in Obstetrics and Gynecology — Thu, 14 May 2009 04:00:00 +0100

Hemoperitoneum is accepted as an indication for surgery in women with tubal ectopic pregnancy. The aim of this pilot study was to evaluate the feasibility of managing such women non-surgically.This was a prospective observational study. Women with tubal ectopic pregnancy and hemoperitoneum detected on transvaginal sonography (TVS) were managed as inpatients either expectantly or with methotrexate (MTX). Inclusion criteria for conservative management were: compliance, clinical stability, absence of acute abdomen, stable hemoglobin level on two measurements (0 and 12-24 h apart), serum human chorionic gonadotropin (hCG) < 5000 IU/L, absence of fetal cardiac activity on TVS and absence of significant hemoperitoneum, defined as blood above the level of the uterine fundus and/or in Morison's po...

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Ultrasound in Obstetrics and Gynecology — Mon, 11 May 2009 04:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

What is the best transperineal ultrasound parameter for predicting success of vacuum extraction?

Ultrasound in Obstetrics and Gynecology — Mon, 11 May 2009 04:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Tomographic ultrasound imaging of the pelvic floor: which levels matter most?

Ultrasound in Obstetrics and Gynecology — Mon, 11 May 2009 04:00:00 +0100

In this study we aimed to determine which levels of the levator hiatus are associated with alterations in ultrasound parameters of pelvic organ support.This was a subanalysis of a study conducted in 296 women seen before and after their first delivery. We analyzed postpartum changes in bladder neck descent and hiatal area as indicators of altered pelvic organ support. Tomographic ultrasound examination was performed on volumes obtained at maximal pelvic floor muscle contraction, at 2.5-mm slice intervals, from 5 mm below to 12.5 mm above the plane of minimal hiatal dimensions.Two hundred and eight recruits (70%) returned for a postnatal appointment. Of these, 130 had delivered vaginally and 26 (20%) were diagnosed with an avulsion injury. An abnormality in slices 3-8 was associated with in...

Doppler flow velocity waveforms in the embryonic chicken heart at developmental stages corresponding to 5-8 weeks of human gestation

Ultrasound in Obstetrics and Gynecology — Mon, 11 May 2009 04:00:00 +0100

To obtain Doppler velocity waveforms from the early embryonic chicken heart by means of ultrasound biomicroscopy and to compare these waveforms at different stages of embryonic development.We collected cardiac waveforms using high-frequency Doppler ultrasound with a 55-MHz transducer at Hamburger-Hamilton (HH) stages 18, 21 and 23, which are comparable to humans at 5 to 8 weeks of gestation. Waveforms were obtained at the inflow tract, the primitive left ventricle, the primitive right ventricle and at the outflow tract in 10 different embryos per stage. M-mode recordings were collected to study opening and closure of the cushions. By exploring the temporal relationship between the waveforms, using a secondary Doppler device, cardiac cycle events were outlined.Our results demonstrate that s...

First-trimester fetal nasal bone length in an ethnic Chinese population

Ultrasound in Obstetrics and Gynecology — Sun, 10 May 2009 04:00:00 +0100

To determine reference ranges of fetal nasal bone length (NBL) in a Chinese population and to assess the value of NBL measurement in screening for chromosomal defects in the first trimester.In this prospective study the fetal profile was examined and the fetal NBL and crown-rump length (CRL) were measured in Chinese women presenting with singleton pregnancies for first-trimester screening for aneuploidy between January 2004 and June 2007. Screening was performed on the basis of nuchal translucency (NT) measurement and maternal serum free [beta]-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels.NBL was measured in 7543 fetuses, of which 7517 were euploid. The best fit equation for median NBL in euploid fetuses in relation to CRL was: NBL (mm) = 0.4593 + (0.0186 �...

Effect of deviation of nuchal translucency measurements on the performance of screening for trisomy 21

Ultrasound in Obstetrics and Gynecology — Thu, 30 Apr 2009 04:00:00 +0100

To examine the effect of deviations in median nuchal translucency thickness (NT) and the spread in measurements on the performance of screening for trisomy 21 by maternal age and fetal NT, and by maternal age, fetal NT and maternal serum biochemistry.We simulated the NT and multiples of the median values for pregnancy-associated plasma protein-A (PAPP-A) and free [beta]-human chorionic gonadotropin ([beta]-hCG) for 500 000 euploid and 500 000 trisomy 21 pregnancies at 12 weeks of gestation. Detection rates for trisomy 21 and false-positive rates were calculated without adjustments in NT and by adding or subtracting values ranging from 0.1 to 1.0 mm to each observed measurement. In addition, the effects of variation in the scatter of NT measurements were examined by applying a multiplicativ...

Standardization of the first-trimester fetal cardiac examination using spatiotemporal image correlation with tomographic ultrasound and color Doppler imaging

Ultrasound in Obstetrics and Gynecology — Wed, 29 Apr 2009 04:00:00 +0100

The challenges of the first-trimester examination of the fetal heart may in part be overcome by technical advances in three-dimensional (3D) ultrasound techniques. Our aim was to standardize the first-trimester 3D imaging approach to the cardiac examination to provide the most consistent and accurate display of anatomy.Low-risk women with normal findings on first-trimester screening at 11 to 13 + 6 weeks had cardiac ultrasound using the following sequence: (1) identification of the four-chamber view; (2) four-dimensional (4D) volume acquisition with spatiotemporal image correlation (STIC) and color Doppler imaging (angle = 20°, sweep 10 s); (3) offline, tomographic ultrasound imaging (TUI) analysis with standardized starting plane (four-chamber view), slice number and thickness; (4) asses...

Ultrasound-derived fetal size nomogram for a sub-Saharan African population: a longitudinal study

Ultrasound in Obstetrics and Gynecology — Tue, 28 Apr 2009 04:00:00 +0100

To create a fetal size nomogram for use in sub-Saharan Africa and compare the derived centiles with reference intervals from developed countries.Fetal biometric measurements were obtained at entry to antenatal care (11-22 weeks' gestation) and thereafter at 4-week intervals from pregnant women enrolled in a longitudinal ultrasound study in Kinshasa, Democratic Republic of Congo. The study population comprised 144 singleton gestations with ultrasound-derived gestational age within 14 days of the menstrual estimate. A total of 755 monthly ultrasound scans were included with a mean ± SD of 5 ± 1 (range, 2-8) scans per woman. Estimated fetal weight (EFW) was calculated at each ultrasound examination using the Hadlock algorithm. A general mixed-effects linear regression model that incorporate...

First-trimester uterine artery Doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction

Ultrasound in Obstetrics and Gynecology — Wed, 22 Apr 2009 04:00:00 +0100

To assess the relationship of first-trimester uterine artery Doppler indices with subsequent delivery of small-for-gestational age (SGA) neonates or intrauterine growth restriction (IUGR).This was a prospective study in which uterine artery Doppler assessment was performed at 11-14 weeks in 3010 women with singleton pregnancies. Resistance indices (RI) and incidence of bilateral notching were compared between women with normal pregnancies (n = 2445) and those who delivered: SGA neonates (birth weight < 10th centile) (n = 377); SGA neonates who had been affected by pre-eclampsia (n = 27); IUGR neonates (birth weight < 10th centile and abnormal Doppler indices) with delivery [ge] 37 weeks (n = 62); and IUGR neonates requiring preterm delivery (delivery < 37 weeks) (n = 36).The first-trimeste...

Conservative management of spontaneous heterotopic cervical pregnancy using an aspiration cannula and pediatric Foley catheter

Ultrasound in Obstetrics and Gynecology — Tue, 21 Apr 2009 04:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Successful outcome of an idiopathic thrombosis of the fetal inferior vena cava

Ultrasound in Obstetrics and Gynecology — Tue, 21 Apr 2009 04:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Hypoplastic left heart syndrome diagnosed in fetal life: associated findings, pregnancy outcome and results of palliative surgery

Ultrasound in Obstetrics and Gynecology — Sat, 18 Apr 2009 04:00:00 +0100

To analyze the main prenatal characteristics of hypoplastic left heart syndrome (HLHS), its association with extracardiac anomalies including increased nuchal translucency (NT) and the outcome of affected patients.We searched our database for classical forms of HLHS (aortic atresia, mitral and aortic atresia and critical aortic stenosis evolved to a severely hypoplastic left ventricle) prenatally diagnosed between 1998 and 2006. Data on 101 fetuses were retrieved and analyzed.The main reason for referral was suspected heart defect on a routine ultrasound scan (82%). The mean gestational age at diagnosis was 21 weeks. Most cases were detected at [le] 22 weeks (72%), the upper limit for termination of pregnancy (TOP) in our country (Spain). An intact atrial septum was diagnosed in 11 of the ...

Impact of audit of routine second-trimester cardiac images using a novel image-scoring method

Ultrasound in Obstetrics and Gynecology — Thu, 09 Apr 2009 04:00:00 +0100

To assess the impact of using an objective scoring method to audit cardiac images obtained as part of the routine 21-23-week anomaly scan.A prospective audit and re-audit (6 months later) were conducted on cardiac images obtained by sonographers during the routine anomaly scan. A new image-scoring method was devised based on expected features in the four-chamber and outflow tract views. For each patient, scores were awarded for documentation and quality of individual views. These were called 'Documentation Scores' and 'View Scores' and were added to give a 'Patient Score' which represented the quality of screening provided by the sonographer for that particular patient (maximum score, 15). In order to assess the overall performance of sonographers, an 'Audit Score' was calculated for each ...

Removal of focal intracavitary lesions results in cessation of abnormal uterine bleeding in the vast majority of women

Ultrasound in Obstetrics and Gynecology — Thu, 09 Apr 2009 04:00:00 +0100

No Abstract. (Source: Ultrasound in Obstetrics and Gynecology)

Two- and three-dimensional saline contrast sonohysterography: interobserver agreement, agreement with hysteroscopy and diagnosis of endometrial malignancy

Ultrasound in Obstetrics and Gynecology — Thu, 09 Apr 2009 04:00:00 +0100

The aims of our study were to compare the interobserver reproducibility of two-dimensional (2D) and three-dimensional (3D) saline contrast sonohysterography (SCSH) and agreement of these techniques with hysteroscopy, and to determine which SCSH findings best discriminate between benign and malignant endometrium.Consecutive women with postmenopausal bleeding and endometrial thickness [ge] 4.5 mm underwent 2D and 3D SCSH; the results were videotaped and stored electronically, respectively, for analysis by two independent experienced examiners who were blinded to each other's results. A histological diagnosis was obtained by dilatation and curettage, hysteroscopic resection or hysterectomy. The hysteroscopist was blinded to the ultrasound results and used the same standardized research protoc...

Extracardiac lesions and chromosomal abnormalities associated with major fetal heart defects: comparison of intrauterine, postnatal and postmortem diagnoses

Ultrasound in Obstetrics and Gynecology — Thu, 09 Apr 2009 04:00:00 +0100

The clinical outcome of prenatally diagnosed congenital heart defects (CHD) continues to be affected significantly by associated extracardiac and chromosomal abnormalities. We sought to: determine the frequency and type of major extracardiac abnormalities (with impact on quality of life) and chromosomal abnormalities associated with fetal CHD; and compare the extracardiac abnormalities detected prenatally to the postnatal and autopsy findings in affected fetuses, to find the incidence of extracardiac abnormalities missed on prenatal ultrasound.We reviewed the computerized database of the Division of Cardiology of the Hospital for Sick Children in Toronto to identify all cases of major CHD detected prenatally from 1990 to 2002. Medical records, fetal echocardiograms and ultrasound, cytogene...

Identification of fetuses with hemoglobin Bart's disease using middle cerebral artery peak systolic velocity

Ultrasound in Obstetrics and Gynecology — Mon, 06 Apr 2009 04:00:00 +0100

To determine the sensitivity and specificity of middle cerebral artery peak systolic velocity (MCA-PSV) in mid-pregnancy for the identification of homozygous [alpha]-thalassemia-1 (hemoglobin (Hb) Bart's disease) in fetuses at risk of the disease.A total of 88 pregnancies (91 fetuses) at risk of Hb Bart's disease and undergoing MCA-PSV measurement before cordocentesis at 18-22 weeks of gestation were recruited into the study. Definitive diagnosis was made using the gold standard technique of Hb typing by high-performance liquid chromatography.The mean ± SD age of the 88 pregnant women recruited into the study was 28.3 ± 5.7 years, the gestational age was 18.8 ± 1.1 weeks and the incidence of Hb Bart's disease was 22% (20 fetuses). Using MCA-PSV above 1.5 multiples of the median as a cut...

Fetal aortic isthmus blood flow and the fraction of cardiac output distributed to the upper body and brain at 11- 20 weeks of gestation

Ultrasound in Obstetrics and Gynecology — Mon, 06 Apr 2009 04:00:00 +0100

To measure serial changes in fetal aortic isthmus (AI) blood flow and estimate the fraction of fetal cardiac output distributed to the upper body, including the brain, at 11-20 weeks of gestation.Using pulsed-wave Doppler and two-dimensional ultrasound, blood flow velocities and inner diameter of the AI, aortic valve (AV) and pulmonary valve (PV) were measured longitudinally in 143 fetuses and volume blood flows (Q) were calculated for each site using the formula: Q (mL/min) = [pi]× (diameter/2)2 × velocity time integral × heart rate × 60. The sum of Qav and Qpv constituted the combined cardiac output (CCO) and the fraction (%) of the upper body (including brain) blood flow was calculated as: (Qav-Qai)×100/CCO.AI blood velocities as well as the vessel diameter increased with advancing...

Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation

Ultrasound in Obstetrics and Gynecology — Tue, 31 Mar 2009 04:00:00 +0100

We examined the performance of two screening strategies: first, assessment of the a-wave in all patients and, second, first-stage screening using the combined test in all patients followed by second-stage assessment of the a-wave only in those with an intermediate risk of one in 51 to one in 1000 after the first stageReversed a-wave was observed in 3.2% of the euploid fetuses, and in 66.4%, 58.3%, 55.0% and 75.0% of fetuses with trisomies 21, 18 and 13 and Turner syndrome, respectively. Inclusion of ductus venosus flow in all pregnancies would detect 96%, 92%, 100% and 100% of trisomies 21, 18 and 13 and Turner syndrome, respectively, at a false-positive rate of 3%. The same detection rates were achieved with the two-stage strategy at a false-positive rate of 2.6%, in which it was necessar...

Three-dimensional sonographic calculation of the volume of intracranial structures in growth-restricted and appropriate-for-gestational age fetuses

Ultrasound in Obstetrics and Gynecology — Fri, 27 Mar 2009 04:00:00 +0100

To evaluate the feasibility and reproducibility of volume segmentation of fetal intracranial structures using three-dimensional (3D) ultrasound imaging, and to estimate differences in the volume of intracranial structures between intrauterine growth-restricted (IUGR) and appropriate-for-gestational age (AGA) fetuses.Total intracranial, frontal, thalamic and cerebellar volumes were measured using 3D ultrasound imaging and Virtual Organ Computer-aided AnaLysis (VOCAL) in 39 IUGR and 39 AGA fetuses matched for gestational age, at 28-34 weeks of gestation. Volumes of, and ratios between, structures were estimated, and differences between IUGR and AGA fetuses were calculated. Volume measurements were performed by two observers, and interobserver and intraobserver intraclass correlation coeffici...

Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis

Ultrasound in Obstetrics and Gynecology — Sat, 21 Mar 2009 04:00:00 +0100

In the context of the planned International Society of Ultrasound in Obstetrics and Gynecology-World Health Organization multicenter study for the development of fetal growth standards for international application, we conducted a systematic review and meta-analysis to evaluate the safety of human exposure to ultrasonography in pregnancy.A systematic search of electronic databases, reference lists and unpublished literature was conducted for trials and observational studies that assessed short- and long-term effects of exposure to ultrasonography, involving women and their fetuses exposed to ultrasonography, using B-mode or Doppler sonography during any period of pregnancy, for any number of times. The outcome measures were: (1) adverse maternal outcome; (2) adverse perinatal outcome; (3) ...

Sonographic study of the decidua basalis in the first trimester of pregnancy

Ultrasound in Obstetrics and Gynecology — Tue, 17 Mar 2009 04:00:00 +0100

To describe the sonographic appearance of the decidua basalis and its changes in the first trimester of pregnancy.We reviewed images from 159 first-trimester ultrasound examinations in 105 women with uncomplicated pregnancies who later delivered at term. The appearance of the decidua basalis layer and the sonographic changes that it underwent, including in echogenicity and thickness, were analyzed with respect to gestational age.A distinct decidual layer could be identified consistently at 5-6 weeks' gestation and its thickness peaked at 6-7 weeks. It was seen inconsistently at 8-9 weeks and was not identifiable by 10 weeks. Its appearance changed over time, from a uniformly echogenic layer at 5-6 weeks to a heterogeneous echogenic layer at 7 weeks, corresponding to the histological eviden...

Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample

Ultrasound in Obstetrics and Gynecology — Wed, 11 Mar 2009 04:00:00 +0100

Short cervical length is an important risk factor for preterm delivery. However, because cervical length changes throughout pregnancy, adequate risk estimation needs to take into account the gestational age (GA) at which the measurement is taken. We aimed to model cervical changes throughout pregnancy in order to be able to use Z-scores, avoiding the confounding effect of GA.Cervical length was prospectively measured in singleton pregnancies, as part of routine antenatal care over a 3-year period. Measurements were taken at GA ranging from 16 to 36 weeks and only one measurement per pregnancy was used in the analysis. Because cervical length measurements are not normally distributed, we used a non-parametric approach (LMS method) to best describe the distribution of the measurements with g...

Volumetric (3D) imaging reduces inter- and intraobserver variation of fetal biometry measurements

Ultrasound in Obstetrics and Gynecology — Tue, 10 Mar 2009 04:00:00 +0100

To compare the inter- and intraobserver variation of fetal biometric measurements utilizing two-dimensional (2D) and three-dimensional (3D) ultrasound imaging.This prospective study, utilizing three pairs of doctors trained in sonography, evaluated singleton pregnancies in the mid-trimester. Measurements of the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were taken in duplicate by each doctor using 2D imaging and then again using 3D volume datasets. Each set of paired doctors evaluated 12 patients. Inter- and intraobserver variation were calculated as the SD of the difference between paired measurements performed by the doctor pairs and by the individual doctors, respectively. Bland-Altman plots were used to visually compare measur...