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Sökning: hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Radiologi och bildbehandling) > Marsal Karel

  • Resultat 1-10 av 46
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1.
  • Larsson, Anna-Karin, et al. (författare)
  • Parents’ Worried State of Mind When Fetal Ultrasound Shows an Unexpected Finding
  • 2009
  • Ingår i: Journal of ultrasound in medicine. - 0278-4297 .- 1550-9613. ; 28:12, s. 1663-1670
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Most parents yearn for a second-trimester ultrasound examination and feel excitement about it, but some also worry about what the examination will show. According to prior research, using only generic instruments or specific questionnaires, anxiety decreases when the ultrasound findings are normal. The aim of this study was to compare parents’ worry (Parents’ Expectations, Experiences, and Reactions to Ultrasound [PEER-U] State of Mind Index) and sense of coherence before and after a routine second-trimester ultrasound examination when it showed normal or abnormal findings. Methods. A 1-year cohort study was performed at a Swedish university hospital. A total of 2049 parents who had their second-trimester ultrasound examinations there filled in a questionnaire consisting of 2 parts before and after the examinations. Results. Parents with normal ultrasound findings were less worried than parents with abnormal findings. The group with normal findings also showed less worry after the examination than before. A sex analysis showed similar patterns. Conclusions. Parents with abnormal ultrasound findings are more worried and anxious. The new instrument, the PEER-U State of Mind Index, not only measures parents’ worry but can also expose what influences their ultrasound examination experience.
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  • Thuring, Ann, et al. (författare)
  • Doppler Audio Signal Analysis as an Additional Tool in Evaluation of Umbilical Artery Circulation
  • 2017
  • Ingår i: Ultraschall in der Medizin. - : Georg Thieme Verlag KG. - 1438-8782. ; 38:5, s. 549-555
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To investigate the predictive capacity of a new method for sound spectrum analysis of Doppler signals recorded from the umbilical artery in high-risk pregnancies. Material and Methods: The retrospective study comprised 127 pregnant women with various pregnancy complications between 23 and 39 gestational weeks. Umbilical artery blood flow velocity waveforms were recorded with Doppler ultrasound and characterized by pulsatility index (PI) and blood flow class (BFC). Doppler audio signals were stored on a digital video recorder and the sound frequency at the energy level 15 dB below its peak (MAXpeak-15 dB) was estimated off-line. The prediction of probability for composite adverse pregnancy outcome (operative delivery for fetal distress, admission to neonatal intensive care unit, perinatal death) was evaluated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. Results: With increasing umbilical artery BFC, the MAXpeak-15 dB frequencies decreased (p < 0.0001) and the PI increased (p < 0.0001). The ROC AUCs for adverse outcome for MAXpeak-15 dB and for PI were 0.842 and 0.836 (p = 0.88), respectively. For the combination of MAXpeak-15 dB and PI, the corresponding AUC was 0.894, significantly higher than that of PI (p < 0.03) and of MAXpeak-15 dB (p < 0.05). Conclusion: Umbilical artery Doppler sound spectrum analysis might be a useful supplement to PI in the clinical evaluation of fetoplacental circulation.
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  • Brodszki, Jana, et al. (författare)
  • Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?
  • 2002
  • Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 19:3, s. 229-234
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition.
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  • Brodszki, Jana, et al. (författare)
  • Early intervention in management of very preterm growth-restricted fetuses : 2-year outcome of infants delivered on fetal indication before 30 gestational weeks
  • 2009
  • Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 34:3, s. 288-296
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered on fetal indication before 30 gestational weeks.METHODS: Between 1998 and 2004, 42 fetuses with intrauterine growth restriction (IUGR) and ARED in the umbilical artery were delivered liveborn by Cesarean section on fetal indication before 30 gestational weeks. The median gestational age at delivery was 27 + 1 (range, 24 + 4 to 29 + 5) weeks. An additional four fetuses died in utero at a median gestational age of 24 + 2 (range, 23 + 5 to 25 + 4) weeks. Neonatal morbidity, infant mortality and major neurological morbidity of liveborn infants were compared with those in two control groups: all 371 liveborn infants delivered at < 30 weeks during the corresponding time period (Group A) and a subset of these, 42 matched infants without IUGR (Group B).RESULTS: Thirty-two fetuses (76%) [corrected] were delivered within 48 h of the occurrence of ARED (25 absent, seven reversed end-diastolic flow). The remaining 10 fetuses (five absent, five reversed end-diastolic flow) were monitored for a median of 6.5 (range, 3-18) days before delivery. One infant died in the neonatal period and three during the first year of postnatal life (2-year survival 90%). The incidence of chronic lung disease was higher in the ARED Group than in Control Groups A and B (P = 0.001 and P = 0.03, respectively). There were no differences between the groups in the occurrence of necrotizing enterocolitis, cerebral hemorrhage or retinopathy of prematurity. Cerebral palsy was diagnosed in 14% of the index group compared with 11% and 17% of Control Groups A and B (P > 0.05).CONCLUSIONS: Very preterm growth-restricted fetuses with umbilical artery ARED delivered on fetal indication, in most cases before the occurrence of severe changes in the ductus venosus velocity waveforms and/or fetal heart rate tracings, showed high 2-year survival and low morbidity.
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  • Gardiner, H, et al. (författare)
  • Ventriculovascular physiology of the growth-restricted fetus
  • 2001
  • Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 18:1, s. 47-53
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To examine the mechanisms by which intrauterine growth restriction may influence later cardiovascular risk by comparing the ventriculovascular physiology of gestational age- and weight-matched growth-restricted and normal fetuses. DESIGN: A prospective longitudinal observational study of 20 normal fetuses studied from 20 weeks to term at monthly intervals was compared with a growth-restricted cohort examined in the interval between diagnosis and delivery. The last values before delivery of the growth-restricted cohort were compared with the normal cohort in two analyses matched for weight and for gestation. Arterial and venous vessel wall physiology and aortic pulse wave velocity were examined longitudinally in the thoracic descending aorta and inferior vena cava using an ultrasonic phase-locked echo-tracking system. Serial echocardiographic examinations were performed assessing structure, ventricular dimensions, function and Doppler flows. RESULTS: There was a linear increase in cardiac preload and relative pulse amplitude in the inferior vena cava with gestation. In normal fetuses, the aortic pulse wave velocity, maximum incremental and late decremental velocities increased with gestation whilst the relative pulse amplitude decreased reflecting falling distal impedance. In both age- and weight-matched analyses, the growth-restricted fetuses showed significantly reduced values reflecting the chronic fetal ventriculovascular responses to increased placental impedance. Pulse wave velocity increased with gestation and was significantly less in the growth-restricted cohort. CONCLUSIONS: Growth restriction is associated with abnormal ventriculovascular physiology that represents a successful adaptive response to raised placental impedance and reduction in wall stress as evidenced by the lower fetal pulse wave velocity in growth-restricted fetuses. However, whilst fetal adaptive mechanisms may aid survival they may result in cerebral and vascular abnormalities that prejudice later cardiovascular health.
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