| 1. |
- Ameye, L., et al.
(author)
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A scoring system to differentiate malignant from benign masses in specific ultrasound-based subgroups of adnexal tumors
- 2009
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 33:1, s. 92-101
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Journal article (peer-reviewed)abstract
- Objective To investigate if the prediction of malignant adnexal masses can be improved by considering different ultrasound-based subgroups of tumors and constructing a scoring system for each subgroup instead of using a risk estimation model applicable to all tumors. Methods We used a multicenter database of 1573 patients with at least one persistent adnexal mass. The masses were categorized into four subgroups based on their ultrasound appearance: ( 1) unilocular cyst; ( 2) multilocular cyst; ( 3) presence of a solid component but no papillation; and ( 4) presence of papillation. For each of the four subgroups a scoring system to predict malignancy was developed in a development set consisting of 754 patients in total ( respective numbers of patients: ( 1) 228; ( 2) 143; ( 3) 183; and ( 4) 200). The subgroup scoring system was then tested in 312 patients and prospectively validated in 507 patients. The sensitivity and specificity, with regard to the prediction of malignancy, of the scoring system were compared with that of the subjective evaluation of ultrasound images by an experienced examiner ( pattern recognition) and with that of a published logistic regression (LR) model for the calculation of risk of malignancy in adnexal masses. The gold standard was the pathological classification of the mass as benign or malignant ( borderline, primary invasive, or metastatic). Results In the prospective validation set, the sensitivity of pattern recognition, the LR model and the subgroup scoring system was 90% (129/143), 95% (136/143) and 88% (126/143), respectively, and the specificity was 93% (338/364), 74% (270/364) and 90% (329/364), respectively. Conclusions In the hands of experienced ultrasound examiners, the subgroup scoring system for diagnosing malignancy has a performance that is similar to that of pattern recognition, the latter method being the best diagnostic method currently available. The scoring system is less sensitive but more specific than the LR model. Copyright (C) 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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| 2. |
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| 3. |
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| 4. |
- Brodszki, Jana, et al.
(author)
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Early intervention in management of very preterm growth-restricted fetuses : 2-year outcome of infants delivered on fetal indication before 30 gestational weeks
- 2009
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In: 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
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Journal article (peer-reviewed)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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| 5. |
- Bui, TH
(author)
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Prenatal cytogenetic diagnosis: gone FISHing, BAC soon!
- 2007
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In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692. ; 30:3, s. 247-251
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Research review (peer-reviewed)
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| 6. |
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| 7. |
- Demidow, V N, et al.
(author)
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Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors
- 2008
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 31:1, s. 85-91
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Journal article (peer-reviewed)abstract
- Objective To describe the clinical history and ultrasound findings in women with ovarian Sertoli cell, Sertoli-Leydig cell and Leydig cell tumors. Methods Women with a histological diagnosis of Sertoli cell tumor, Sertoli-Leydig cell tumor or Leydig cell tumor who bad undergone preoperative ultrasound examination were identified from the databases of each of three participating ultrasound centers. The tumors were characterized on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions published by the International Ovarian Tumor Analysis (IOTA) group. In addition, all images were reviewed and described using pattern recognition. Results Of 22 patients identified, 15 bad Sertoli-Leydig cell tumors, two bad Sertoli cell tumors and five bad Leydig cell tumors. Four patients were postmenopausal, one 48-year-old woman bad undergone hysterectomy, 16 were of fertile age and one was a 4-year-old girl. Most patients (82%, 18122) bad endocrine symptoms, the most common being bleeding disturbance (64%, 14122) and hirsutism (32%, 7/22). Twenty-two (96%) of 23 tumors (one woman bad bilateral tumors) contained a solid component; 16 (70%) were purely solid. Pattern recognition showed that the Leydig cell tumors were small solid tumors (four of five had a largest diameter of 1-3 cm) and the two Sertoli cell tumors were somewhat larger solid tumors (4 cm and 7 cm); the Sertoli-Leydig cell tumors were either small (3-4 cm) or medium-sized (6- 7 cm) solid tumors, or multilocular solid tumors of any size (3-18 cm) with purely solid areas mixed with areas of innumerable closely packed small cyst locules. Conclusions On the basis of endocrine symptoms, the woman's age and ultrasound findings, it should be possible to suggest a correct preoperative diagnosis of Sertoli cell, Sertoli-Leydig cell or Leydig cell tumors in many cases.
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| 8. |
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| 9. |
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| 11. |
- Fu, Jing, et al.
(author)
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Fetal ductus venosus, middle cerebral artery and umbilical artery flow responses to uterine contractions in growth-restricted human pregnancies.
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 30:6, s. 867-873
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Journal article (peer-reviewed)abstract
- Objective To explore fetal ductus venosus (DV) flow velocity changes relative to umbilical artery (UA) blood flow and brain-sparing flow (BSF) during uterine contractions. Methods Forty-five term fetuses suspected of having growth restriction were exposed to an oxytocin challenge test (OCT) with simultaneous Doppler velocimetry in the UA, middle cerebral artery (MCA) and DV. Basal BSF was defined as a MCA-to-UA pulsatility index (PI) ratio of < 1.08, and de novo BSF as a decrease in MCA-PI of >= 1 SD (equivalent to a value of 0.24 units) during the OCT. Results Basal DV flow velocities were lower in the BSF group (n = 7) than they were in the non-BSF group (n = 3 8). During the OCT, D V flow velocity parameters changed in neither group but MCA-PI decreased in the non-BSF group. A crude de novo BSF was not associated with DV flow velocity changes, but when UA-PI changes were considered, a serial relationship was found between decreased UA-PI, increased DV flow velocity, and decreased MCA-PI When UA-PI increased, the MCA-PI still decreased (though not significantly) but DV flow velocity parameters remained unchanged. Conclusions Established fetal BSF is associated with low DV flow velocities, but in an acute sequence there might be two contrasting courses along which BSF develops: one with an increase and one with a decrease in the UA vascular flow resistance. In the former situation the DV flow velocity increases, while in the latter situation the role of the DV in the acute redistribution of fetal blood flow is unclear. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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| 12. |
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| 13. |
- Georgsson Öhman, Susanne, et al.
(author)
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Second-trimester routine ultrasound screening : expectations and experiences in a nationwide Swedish sample
- 2008
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In: Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 32:1, s. 15-22
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience. METHOD: Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999. RESULTS: The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group. CONCLUSION: Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.
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| 14. |
- Ghosh, Gisela, et al.
(author)
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Pulsations in the umbilical vein during labor are associated with increased risk of operative delivery for fetal distress.
- 2009
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In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 34:2, s. 177-181
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Journal article (peer-reviewed)abstract
- OBJECTIVES: 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). METHODS: 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. Presence or absence of pulsations in the UV were noted and related to perinatal outcome. RESULTS: Pulsations in the UV were seen in eight (30.8%) of the fetuses with pathological CTG, of which six (75%) underwent ODFD. No pulsations were seen in the other 18 (69.2%) fetuses with pathological CTG and these were all delivered without ODFD. No pulsations were seen in the UV in the fetuses with normal CTG and these were all delivered without ODFD. Among the fetuses with pathological CTG, there was an increased risk of ODFD in fetuses with vs. those without pulsations in the UV (P < 0.0001). CONCLUSIONS: Pulsations in the UV can be observed in human fetuses during suspected intrapartum hypoxia and these pulsations are associated with an increased risk of ODFD. Doppler examination of the UV might give important additional information on fetal condition during labor and delivery. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 15. |
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| 16. |
- Hernandez-Andrade, E., et al.
(author)
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Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth-restricted fetuses
- 2008
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 32:1, s. 71-76
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Journal article (peer-reviewed)abstract
- Objectives To study regional cerebral blood perfusion with power Doppler ultrasound (PDU) imaging in appropriate-for-gestational age (AGA) fetuses and those with intrauterine growth restriction (IUGR) at different hemodynamic stages of fetal deterioration. Methods Brain blood perfusion was studied with PDU imaging, and the fractional moving blood volume (FMB V) was estimated in 56 growth-restricted and 56 AGA matched fetuses at 26-32 weeks of gestation. Fetuses with IUGR were classified according to progressi. on of hemodynamic deterioration as follows: Group 1, abnormal umbilical artery (UA) pulsatility index (PI) (mean > 2 SD, n = 13); Group 2, abnormal UA-PI and middle cerebral artery (MCA) PI (mean < 2 SD, n = IS); Group 3, abnormal UA-PI, MCA-PI and ductus venosus (D V) PI (mean > 2 SD) but atrial (a-wave) flow present (n = 16); and Group 4, absent or reversed DV atrial flow (n = 12). FMBV was calculated in the complete mid-sagittal, frontal, basal ganglia and cerebellar regions. Results In all growth-restricted fetuses, FMBV was significantly increased in all regions. Fetuses in Group 1 showed considerable increments in FMBV values in the frontal, complete mid-sagittal and cerebellar regions, and a mild increase in the basal ganglia. From Groups 2 to 4, there was a steady reduction (compared with Group 1) in frontal FMBV values (F = 3.25, P = 0.027) together with a significant increment in the basal ganglia values (F = 11.61, P < 0.001). A trend for increasing FMBV values was also observed in the cerebellum, whereas a decreasing trend was noted in the complete mid-sagittal area. Conclusions Brain perfusion in growth-restricted fetuses shows clear regional variations, which change with progression of hemodynamic deterioration. After an initial and early increase in the frontal area, progression of fetal deterioration was rapidly associated with a pronounced decrease in frontal perfusion, together with an increase towards the basal ganglia. Copyright (c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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| 17. |
- Hernandez-Andrade, E., et al.
(author)
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Evaluation of fetal regional cerebral blood perfusion using power Doppler ultrasound and the estimation of fractional moving blood volume
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 29:5, s. 556-561
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Journal article (peer-reviewed)abstract
- Objective To standardize the evaluation of regional fetal brain blood perfusion, using power Doppler ultrasound (PDU) to estimate the fractional moving blood volume (FMBV) and to evaluate the reproducibility of this estimation. Methods Brain blood perfusion was evaluated in 35 normally grown fetuses at 28-30 weeks of gestation, using PDU. The following cerebral regions were included in the PDU color box: anterior sagittal, complete sagittal, basal ganglia, and cerebellar. Ten consecutive good-quality images of each anatomical plane were recorded and the delimitation of the region of interest (ROI) was performed off-line. FMBV was quantified in the ROI of all images and the mean considered as the final value. Differences between regions, variability, reproducibility and agreement between observers were assessed. Results Power Doppler images of the described anatomical planes were obtained in all cases, regardless of fetal position. The median time for the acquisition of the images was 7 (range 4-12) min. Mean (range) FMBV values were: anterior sagittal, 16.5 (10.7-22.8)%, inter-patient coefficient of variation (CV) 0.22; complete sagittal, 13.5 (8.8-.16.1)%, CV 0.27; basal ganglia, 18.3 (10.7-27.6) %, CV 0.27; and cerebellar, 6.6 (3.0-11.0) %, CV 0.38. There were statistically significant differences in FMBV between cerebellar and complete sagittal ROIs with the frontal and basal ganglia regions. Reproducibility analyses showed an intraclass correlation coefficient of 0.91 (95% CI 0.67-0.97) and an interclass correlation coefficient of 0.87 (95% CI 0.70-0.94). Interobserver agreement showed a mean difference between observers of -0.2 (SD 2.7) with 95% limits of agreement -5.6 to 5.2. Conclusions When the regions of interest are well defined, the FMBV estimate offers a method to quantify blood flow perfusion in different fetal cerebral areas. There appear to be regional differences in FMBV within the fetal brain. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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| 18. |
- Holst, Rose-Marie, 1946, et al.
(author)
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Cervical length in women in preterm labor with intact membranes: relationship to intra-amniotic inflammation/microbial invasion, cervical inflammation and preterm delivery
- 2006
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In: Ultrasound Obstet Gynecol. - : Wiley. - 0960-7692. ; 28:6, s. 768-74
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Intra-amniotic infection, diagnosed by microbial invasion of the amniotic cavity (MIAC) and/or the presence of intra-amniotic inflammation (IAI), is related to adverse perinatal outcome in women with preterm labor. Due to the subclinical nature of IAI, a correct diagnosis depends on amniocentesis, which is an invasive method not performed as a clinical routine. The aim of this study was to evaluate if cervical length measured by transvaginal sonography could assist in the identification of women at high risk for IAI. METHODS: Cervical length was assessed by transvaginal sonography in 87 women with singleton pregnancies in preterm labor (<34 weeks of gestation). Cervical (n=87) and amniotic (n=55) fluids were collected. Polymerase chain reactions for Ureaplasma urealyticum and Mycoplasma hominis, and culture for aerobic and anaerobic bacteria, were performed. Interleukin (IL)-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay. RESULTS: IAI was present in 25/55 (45%) of the patients presenting with preterm labor who underwent amniocentesis. Women with IAI had a significantly shorter cervical length (median, 10 (range, 0-34) mm) than had those without IAI (median, 21 (range, 11-43) mm) (P<0.0001). Receiver-operating characteristics curve analysis showed that a cervical length (cut-off of 15 mm) predicted IAI (relative risk, 3.6; CI, 1.9-10.0) with a sensitivity of 72%, specificity of 83%, positive predictive value of 78% and negative predictive value of 78%. Cervical length was also significantly associated with preterm birth up to 7 days from sampling and at
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| 19. |
- Jarvela, IY, et al.
(author)
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Evaluation of endometrial receptivity during in-vitro fertilization using three-dimensional power Doppler ultrasound
- 2005
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 26:7, s. 765-769
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Journal article (peer-reviewed)abstract
- Objective To compare sonographic endometrial characteristics in in-vitro fertilization (IVF) cycles between women who conceive and those who do not. Methods Thirty-five women undergoing IVF treatment participated in the study. Using three-dimensional (3D) power Doppler ultrasound, we assessed endometrial patterns, volume and vascularization, after follicle stimulating hormone (FSH) stimulation but before human chorionic gonadotropin (bCG) administration (referred to hereafter as 'after FSH stimulation) and again on the day of oocyte retrieval. Results The pregnancy rate was 37% (13/35). After FSH stimulation, 29 of the 35 women bad a triple-line endometrial pattern, compared with five out of 35 on the day of oocyte retrieval. in those who bad a triple-line pattern after FSH stimulation the pregnancy rate was 44.8% (13/29) and it was 0% (016) in those with a homogeneous pattern (chi-square test, P = 0.039). If a triple-line pattern was present on the day of oocyte retrieval the pregnancy rate was 80.0% (415), whereas if the pattern was homogeneous the pregnancy rate was 30.0% (9/30) (P = 0.032). There were no differences between those who conceived and those who did not in endometrial thickness, volume or vascularization on either day examined. Endometrial volume decreased significantly after bCG injection in women who conceived, but not in those who did not conceive. In both groups endometrial and subendometrial vascularization decreased after bCG injection, while the endometrial thickness remained unchanged. Conclusions The existence of a homogeneous endometrial pattern after FSH stimulation seems to be a prognostic sign of an adverse outcome in IVF, while a triple-line pattern after FSH stimulation and a decrease in endometrial volume appear to be associated with conception.
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| 20. |
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| 21. |
- Jokubkiene, Ligita, et al.
(author)
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Does three-dimensional power Doppler ultrasound help in discrimination between benign and malignant ovarian masses?
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 29:2, s. 215-225
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Journal article (peer-reviewed)abstract
- Objectives: To determine if tumor vascularity as assessed by three-dimensional (3D) power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, if adding 3D power Doppler ultrasound to gray-scale imaging improves differentiation between benignity and malignancy, and if 3D power Doppler ultrasound adds more to gray-scale ultrasound than does two-dimensional (2D) power Doppler ultrasound. Methods: One hundred and six women scheduled for surgery because of an ovarian mass were examined with transvaginal gray-scale ultrasound and 2D and 3D power Doppler ultrasound. The color content of the tumor scan was rated subjectively by the ultrasound examiner on a visual analog scale. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated in the whole tumor and in a 5-cm(3) sample taken from the most vascularized area of the tumor. Logistic regression analysis was used to build models to predict malignancy. Results: There were 79 benign tumors, six borderline tumors and 21 invasive malignancies. A logistic regression model including only gray-scale ultrasound variables (the size of the largest solid component, wall irregularity, and lesion size) was built to predict malignancy. It bad an area under the receiver-operating characteristics (ROC) curve of 0.98, sensitivity of 100%, false positive rate of 10%, and positive likelihood ratio (LR) of 10 when using the mathematically best cut-off value for risk of malignancy (0.12). The diagnostic performance of the 3D flow index with the best diagnostic performance, i.e. VI in a 5-cm(3) sample, was superior to that of the color content of the tumor scan (area under ROC curve 0.92 vs. 0.80, sensitivity 93 % vs. 78 %, false positive rate 16% vs. 27% using the mathematically best cut-off value). Adding the color content of the tumor scan or FI in a 5-cm(3) sample to the logistic regression model including the three gray-scale variables described above improved diagnostic performance only marginally, an additional two tumors being correctly classified. Conclusions: Even though 2D and 3D power Doppler ultrasound can be used to discriminate between benign and malignant ovarian tumors, their use adds little to a correct diagnosis of malignancy in an ordinary population of ovarian tumors. Objective quantitation of the color content of the tumor scan using 3D power Doppler ultrasound does not seem to add more to gray-scale imaging than does subjective quantitation by the ultrasound examiner using 2D power Doppler ultrasound. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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| 22. |
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| 23. |
- Lindell, G, et al.
(author)
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Sonographic fetal weight estimation in prolonged pregnancy: comparative study of two- and three-dimensional methods.
- 2009
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In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 33, s. 295-300
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To compare two-dimensional (2D) and three-dimensional (3D) ultrasound techniques, including volumetry of fetal thigh, for fetal weight (FW) estimation in prolonged pregnancy, and to develop a new FW estimation formula. METHODS: This prospective comparative study initially included 176 pregnant women. FW estimation was performed at >/= 287 days of gestation within
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| 24. |
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| 25. |
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| 26. |
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| 27. |
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| 28. |
- Mulic-Lutvica, Ajlana, et al.
(author)
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Ultrasound finding of an echogenic mass in women with secondary postpartum hemorrhage is associated with retained placental tissue
- 2006
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In: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 28:3, s. 312-319
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Journal article (peer-reviewed)abstract
- Objectives: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium. Methods: This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population. Results: The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90 th percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped. Conclusion: This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.
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| 29. |
- Nikkilä, Annamari, et al.
(author)
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Fetal growth and congenital malformations.
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 29:3, s. 289-295
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Journal article (peer-reviewed)abstract
- Objectives To ascertain whether the risk for congenital malformations is increased in pregnancies with deviating fetal growth, i.e. in those in which the estimated date of delivery (EDD) was postponed more than 1 week at the second- trimester ultrasound fetometry scan, or those suspected of intrauterine growth restriction at routine ultrasound fetometry in the third trimester. Methods The study period was 1994-2003. We used the Swedish Medical Birth Register to identify pregnancies with appropriate data (n = 605 845). A regional ultrasound database consisting of 73 092 pregnancies was used for more detailed data and analysis of the third-trimester fetal growth. The number of congenital malformations was ascertained from three national health registers. Results We found a moderately increased risk for any malformation in the group of fetuses in which the EDD was postponed > 1 week. The strongest effect was seen for chromosome anomalies and central nervous system malformations, including neural tube defects. In the third trimester, an increased risk for fetal malformations was found in asymmetrically vs. symmetrically growth-restricted fetuses, perhaps more strongly when adjustment of the EDD had been done at the dating scan. Conclusions Fetuses in which the EDD differs between that calculated by the last menstrual period and that calculated by second-trimester ultrasound measurement seem to have an increased risk for congenital malformations, including chromosomal anomalies. A targeted ultrasound examination for malformation screening might be recommended for this group. A similar policy might be recommended when intrauterine growth restriction, especially of the asymmetrical type, is suspected later in pregnancy. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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| 30. |
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| 31. |
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| 32. |
- Opolskiene, Gina, et al.
(author)
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Two- and three-dimensional saline contrast sonohysterography: interobserver agreement, agreement with hysteroscopy and diagnosis of endometrial malignancy.
- 2009
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In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 33:5, s. 574-582
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Journal article (peer-reviewed)abstract
- OBJECTIVES: 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. METHODS: Consecutive women with postmenopausal bleeding and endometrial thickness >/= 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 protocol to describe the uterine cavity as the ultrasound examiners. RESULTS: Of 170 consecutive women with postmenopausal bleeding and endometrial thickness >/= 4.5 mm, 84 (14 with endometrial malignancy) fulfilled our inclusion criteria. Hysteroscopy findings in 54 women (one with endometrial malignancy) were used to determine agreement with SCSH. Interobserver agreement of 2D and 3D SCSH was 95% (80/84) vs. 89% (75/84) with regard to presence of focal lesions, 89% (75/84) vs. 88% (74/84) for presence of focal lesions with irregular surface, 67% (54/81) vs. 63% (51/81) for number of focal lesions, and 77% (46/60) vs. 70% (42/60) for location of focal lesions. The agreement between 2D and 3D SCSH and hysteroscopy was 94% (51/54) vs. 93% (50/54) with regard to presence of focal lesions, 74% (40/54) vs. 76% (41/54) for presence of focal lesions with irregular surface, 63% (34/54) vs. 54% (29/54) for number of focal lesions, and 66% (29/44) vs. 64% (28/44) for location of focal lesions. The SCSH finding that best discriminated between benign and malignant endometrium was the presence of focal lesion(s) with irregular surface (for 2D SCSH: sensitivity 71%, specificity 97%, positive likelihood ratio 25, negative likelihood ratio 0.3; for 3D SCSH: sensitivity 43%, specificity 97%, positive likelihood ratio 15, negative likelihood ratio 0.6). CONCLUSIONS: 3D SCSH does not seem to be superior to 2D SCSH when performed by experienced ultrasound examiners either with regard to reproducibility, agreement with hysteroscopy findings or diagnosis of endometrial malignancy. The presence of focal lesion(s) with irregular surface is the best SCSH variable for discrimination between benign and malignant endometrium. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 33. |
- Opolskiene, Gina, et al.
(author)
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Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness >/= 4.5 mm.
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 30:3, s. 332-340
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Journal article (peer-reviewed)abstract
- Objectives To determine which endometrial morphology characteristics as assessed by gray-scale ultrasound and which endometrial vessel characteristics as assessed by power Doppler ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and sonographic endometrial thickness > 4.5 mm and to develop logistic regression models to calculate the individual risk of endometrial malignancy in women with PMB, endometrial thickness > 4.5 mm, good visibility of the endometrium and detectable Doppler signals in the endometrium. Methods Of 223 consecutive patients with PMB and sonographic endometrial thickness > 4.5 mm, 120 fulfilled our inclusion criteria. They underwent transvaginal gray-scale and power Doppler ultrasound examination, wbich was videotaped for later analysis by two examiners with more than 15 years' experience in gynecological ultrasonography. They independently assessed endometrial morphology and vascularity using predetermined criteria. Their agreed-upon description was compared with the histological diagnosis. Univariate and multivariate logistic regression analyses were used. The best diagnostic test was defined as the one with the largest area under the receiver-operating characteristics curve (AUC). Results Thirty (25%) endometria were malignant. Interobserver agreement for the description of endometrial morphology and vascularity was moderate to good (Kappa 0.49-0.78). The best ultrasound variables to predict malignancy were heterogeneous endometrial echogenicity (AUC 0.83), endometrial thickness (AUC 0.80), and irregular branching of endometrial blood vessels (AUC 0.77). A logistic regression model including endometrial thickness and heterogeneous endometrial echogenicity bad an AUC of 0.91. Its mathematically best risk cut-off yielded a positive likelihood ratio of 4.4, and a negative likelihood ratio of 0.1. Adding Doppler information to the model improved diagnostic performance marginally (AUC 0.92). Conclusions In selected high-risk women with PMB and an endometrial thickness of > 4.5 mm, calculation of the individual risk of endometrial malignancy using regression models including gray-scale and Doppler characteristics can be used to tailor management. These models would need to be tested prospectively before introduction into clinical practice. Copyright (c) 2007 ISUOG. Publisbed by John Wiley & Sons, Ltd.
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| 34. |
- Ornö, A-K, et al.
(author)
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Ultrasonographic anatomy of perineal structures during pregnancy and immediately following obstetric injury.
- 2008
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In: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 32:4, s. 527-534
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To assess perineal anatomy using ultrasound before and immediately after delivery. METHODS: Structures in the perineum were studied by real-time two-dimensional transvaginal and endoanal ultrasound imaging using a combined linear and semicircular (up to 200 degrees sector) probe. We examined 45 nulliparous pregnant women and 44 primiparae immediately after delivery (40 with anal sphincter tears and four without sphincter injury). In each case a single longitudinal image was later assessed by two observers in order to evaluate interobserver agreement. RESULTS: In pregnancy, the perineal membrane, puboperineal muscles, conjoined longitudinal muscle and central point were identified on real-time examination in 91%, 98%, 100% and 100% of cases, respectively. At offline evaluation of the longitudinal images obtained for each of the pregnant women, the percentage of cases in which each structure was identified by both observers ranged from 64% to 100%. In the women who were examined postpartum, all structures were identified by both observers in all four of the women without sphincter injury. In the women with sphincter tears, the perineal membrane, puboperineal muscles, conjoined longitudinal muscle and central point were found by ultrasound to be intact in 10%, 10%, 55% and 18%, respectively. The agreement between two observers regarding identification of intact structures in a single longitudinal image was good for perineal membrane (kappa index, 0.66), fair for puboperineal muscles (kappa index, 0.40), and poor for conjoined longitudinal muscle and central point (kappa index, 0.08 and 0.17, respectively). CONCLUSIONS: Ultrasonography might be helpful in the evaluation of perineal anatomy and extent of perineal tears. However, the relatively poor agreement between the two observers evaluating single linear transvaginal images implies that both transverse and longitudinal projections are necessary to obtain relevant information. Further studies are needed regarding the importance of specific sonographically identified structures and their role in pelvic floor dysfunction after delivery.
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| 35. |
- Paladini, D., et al.
(author)
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Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary
- 2009
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 34:2, s. 188-195
-
Journal article (peer-reviewed)abstract
- Objectives To describe the clinical and ultrasound features of fibroma and fibrothecoma of the ovary. Methods 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 two observers, who described them using pattern recognition. Results Of the 68 patients identified, 53 had fibroma and 15 had fibrothecoma. The mean patient age was 54 (range, 17-80) years. Sixty-three percent (41/65) were postmenopausal and 60% (39/65) had no symptoms. Most (75%; 51/68) fibromas/fibrothecomas were solid tumors and most (75%; 51/68) manifested minimal or moderate blood flow on color Doppler examination. Using pattern recognition, all solid fibromas/fibrothecomas were described as round, oval or slightly lobulated tumors. Most (66%; 29/44) were solid tumors, with regular or slightly irregular internal echogenicity with stripy shadows, and some contained cystic spaces. Others (23%, 10144) were solid tumors with regular or slightly irregular internal echogenicity without stripy shadows and with or without cystic spaces. Two were solid tumors that were so dense it was difficult to assess their internal echogenicity, two were multilocular solid tumors with large cystic spaces and one was described as being mainly cystic. Half of the women with fibroma/fibrothecoma had fluid in the pouch of Douglas and 16% (11/68) had ascites; CA 125 titers >= 35 U/mL were found in 34% (17/50) of the cases in which CA,125 results were available. Conclusions Most fibromas and fibrothecomas are round, oval or lobulated solid tumors that cast stripy shadows and are associated with fluid in the pouch of Douglas, and most manifest minimal to moderate vascularization. A fibroma/fibrothecoma with atypical ultrasound appearance may be mistaken for a malignancy, in particular if associated with fluid in the pouch of Douglas or ascites, high color content and raised CA 125 levels. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 36. |
- Pasquini, L., et al.
(author)
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Z-scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia
- 2007
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In: Ultrasound Obstet Gynecol. - 0960-7692. ; 29:6, s. 628-33
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Prenatal diagnosis of isolated coarctation of the aorta suffers from high false positive and false negative rates. The aim of our study was to develop Z-scores for the aortic isthmus in normal fetuses as a reference for fetuses with suspected coarctation. METHODS: The aortic isthmal diameter, immediately proximal to the insertion of the arterial duct, was measured prospectively in the transverse (three vessel and trachea) and sagittal views in 221 normal fetuses at 18 to 37 weeks' gestation. The ductal diameter was measured immediately before it entered the descending aorta in the same view. All measurements were repeated three times by a single investigator and averaged. A second investigator re-measured the images of 50 cases to assess interobserver variability. Z-scores were created relating isthmal and ductal diameters to femur length and gestational age. The ratio between the isthmal and ductal diameters was calculated. RESULTS: The formula used to calculate Z-scores for the three diameters was: [ln(measured isthmal diameter) - (m ln(femur length or gestational age) + c)]/root MSE, where c is the intercept, m is a multiplier and MSE is the mean squared error. The ratio between isthmal and ductal diameters was close to a constant value of 1 (95% CI 0.97-1.01), regardless of the value of femur length or gestational age. CONCLUSION: We have defined Z-scores for the fetal aortic isthmus and arterial duct measured in the three vessels and trachea view and for the isthmus in the sagittal plane. In suspected coarctation, these Z-scores and the isthmal to ductal ratio may help in longitudinal assessment of the aortic arch and aid in the prenatal diagnosis of coarctation.
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| 37. |
- Romosan, G., et al.
(author)
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Diagnostic performance of routine ultrasound screening for fetal abnormalities in an unselected Swedish population in 2000-2005
- 2009
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 34:5, s. 526-533
-
Journal article (peer-reviewed)abstract
- Objectives 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 front 2000 to 2005, and to describe the consequences of true-positive and false-positive ultrasound diagnoses of fetal malformations. Methods A retrospective analysis was undertaken of all babies born in Malmo, Sweden, between January 2000 and December 2005 by mothers residing in Malmo 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 Malmo. All women underwent two routine scans, at IS and 32 weeks, including scrutiny of the fetal anatomy. Detection rates and false-positive rates were calculated per fetus. Results The prevalence of chromosomally abnormal fetuses was 0.31% (52/16775); that of chromosomally normal fetuses with major and minor malformations was 1.80% (302/16775) and 1.32% (222/16775), respectively. The detection rate of fetuses with major malformations but normal chromosomes was 68% (205/302), with a detection rate at < 22 weeks of 37% (112/302). In addition, 46% (24/52) of all chromosomally abnormal fetuses were diagnosed before birth because a malformation was detected at ultrasound imaging, 33% (17/52) being detected at <22 gestational weeks. In all, 68 pregnancies were terminated because of an ultrasound diagnosis of fetal malformation (0.4% of all pregnancies and 47% of the pregnancies in which a fetal malformation was detected by ultrasound examination before 22 weeks). A false-positive ultrasound diagnosis of malformation was made in 0.19% (31/16180) of the normally formed fetuses and in 20 (0.12%) fetuses the abnormal finding persisted during pregnancy. No fetus assigned a false-positive diagnosis was lost by termination of pregnancy, but most were subjected to one or more unnecessary interventions before birth (e.g. amniocentesis), at birth (e.g. Cesarean section) or after birth (e.g. electrocardiogram, X-ray, ultrasound examination or treatment with antibiotics). Conclusions in a screening program consisting of one fetal anomaly scan at 18 weeks and another at 32 weeks the detection rate of major malformations in chromosomally normal fetuses was 68% with a detection rate of 37% at < 22 weeks. The corresponding detection rates of chromosomally abnormal fetuses were 46% and 33%. Fewer than one in 500 screened fetuses bad an ultrasound diagnosis of an anomaly that was not confirmed after birth. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 38. |
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| 39. |
- Rovas, Linas, et al.
(author)
-
Reference data representative of normal findings at three-dimensional power Doppler ultrasound examination of the cervix from 17 to 41 gestational weeks.
- 2006
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 28:Aug 29, s. 761-767
-
Journal article (peer-reviewed)abstract
- Objectives To develop normal reference ranges for cervical volume and vascular indices using three-dimensional (3D) power Doppler ultrasonograpby from 17 to 41 gestational weeks. Methods This was a cross-sectional study of 352 nulliparous and 291 parous women who delivered at term and underwent transvaginal 3D power Doppler ultrasound examination of the cervix once at 17 to 41 weeks' gestation. We examined approximately 25 women in each gestational week. Cervical volume, vascularization index (VI), flow index (H) and vascularization flow index (VFI) were calculated. Results There was no change in cervical volume between 17 and 40 weeks' gestation. At 41 weeks cervical volume was slightly smaller than it was at 17-40 weeks (P = 0.03 for nulliparous women and P = 0.08 for parous women). The cervical volume was larger in parous than it was in nulliparous women (median 38 cm(3) VS. 32 cm(3) at 17-40 weeks, P < 0.0001; median 31 cm(3) us. 22 cm3 at 41 gestational weeks, P = 0.288). FI did not differ between nulliparous and parous women and remained unchanged between 17 and 41 weeks' gestation (median 30.6, range 21.2-55.2). VI and VFI did not change consistently front 17 to 41 weeks, but the values were higher in parous than they were in nulliparous women at 17-30weeks (median VI 5.3% vs. 3.1%, P < 0.0001; median VFI 1.6 vs. 0.9, P < 0.0001). At 31-41 gestational weeks the median VI for all women irrespective of parity was 4.9% and the median VFI was 1.4. Conclusion Reference values for cervical volume and blood flow indices as assessed by 3D power Doppler ultrasonograpby have been established for the second half of pregnancy. These lay the basis for studies of pathological conditions. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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| 40. |
- Rovas, Linas, et al.
(author)
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Reference data representative of normal findings at two-dimensional and three-dimensional gray-scale ultrasound examination of the cervix from 17 to 41 weeks' gestation.
- 2006
-
In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 27:Dec 30, s. 392-402
-
Journal article (peer-reviewed)abstract
- Objectives To create reference values representative of normal findings on two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination of the cervix from 17 to 41 weeks' gestation and to determine the agreement between cervical measurements taken by 2D and 3D TVS. Methods Cross-sectional study covering 17 to 41 weeks in 419 nulliparous and 360 parous women who delivered at term and who underwent 2D and 3D TVS examination of the uterine cervix. We examined approximately 25 women in each gestational week. The length, anteroposterior (AP) diameter and width of the cervix (and of any cervical funnel) and AP diameter of the cervical canal were measured. Results were plotted against gestational age. The agreement between 2D and 3D ultrasound results was expressed as the mean (+/- 2 SDs) difference between the results of the two methods and as the interclass correlation coefficient (inter-CC). Results There was excellent agreement between measurements taken by 2D and 3D ultrasound (inter-CC values, 0.80-0.98) but measurements of cervical length taken using 3D ultrasound were greater than measurements taken by 2D ultrasound (mean difference, -0.04 +/- 0.36 cm). Cervical length did not change substantially between 17 and 32 gestational weeks but decreased progressively thereafter. Cervical length was similar in nulliparous and parous women at 17-32 weeks, but from 33 weeks the cervix tended to be longer in parous women. In nulliparae, cervical length decreased front a median of 3.8 (range, 0.7-6.1) cm at 17-32 weeks to 2.3 (range, 0.4-6.0) cm at 33-40 weeks and to 0.7 (range, 0.2-1.5) cm at 41 weeks. In parous women, the corresponding figures were 3.9 (range, 1.0-6.1) cm, 3.0 (range, 0.4-5.7) cm and 0.8 (range, 0.4-3.4) cm (results obtained by 3D ultrasound). Cervical AP diameter and width did not differ between nulliparous and parous women. Median AP diameter increased from 3.0 (range, 2.0-4.6) cm at 17-30 weeks to 3.5 (range, 1.8-5.5) cm at 31-40 weeks and to 4.0 (range, 2.8-5.9) cm at 41 weeks. Cervical width was 3.7 (range, 2.3-6.0) cm at 17-30 weeks and 4.5 (range, 2.3-6.1) cm at 31-41 weeks. The percentage of women with funneling increased from 4% (3184) at 17-18 weeks to 63% (12/19) at 41 weeks and the percentage of women with an open cervical canal increased from 19% (15/84) to 72% (13/19). Funneling and opening of the cervical canal were equally common in nulliparous and parous women. Conclusions Reference data provide the basis for studies of pathological conditions. Common reference values for nulliparous and parous women can be used for cervical AP diameter and width from 17 to 41 weeks and for cervical length from 17 to 32 weeks. Separate reference values for cervical length for nulliparous and parous women should be used from 33 to 41 weeks. Copyright (c) 2005 ISUOG. Published by John Wiley & Sons, Ltd.
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| 41. |
- Rovas, Linas, et al.
(author)
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Three-dimensional ultrasound assessment of the cervix for predicting time to spontaneous onset of labor and time to delivery in prolonged pregnancy
- 2006
-
In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 28:3, s. 306-311
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Journal article (peer-reviewed)abstract
- Objectives To determine whether three-dimensional (3D) ultrasound including power Doppler examination of the cervix is useful for predicting time to spontaneous onset of labor or time to delivery in prolonged pregnancy. Methods A prospective study was conducted in 60 women who went into spontaneous labor. All underwent transvaginal 3D power Doppler ultrasound examination of the cervix immediately before a prolonged-pregnancy cbeck-up at >= 41 + 5 gestational weeks. Univariate and multivariate logistic regression analysis was used to determine which of the following variables predicted spontaneous onset of labor > 24 h and > 48 h and vaginal delivery > 48 h and > 60 h: length, anteroposterior (AP) diameter and width of the cervix and of any cervical funneling; cervical volume (cm(3)); vascularization index (VI); flow index (FI); vascularization flow index (VEI); parity; and Bishop score. Multivariate logistic regression analysis was carried out both with and without Bishop score as a predictive variable. Receiver-operating characteristics (ROC) curves were used to describe the diagnostic performance of the tests. Results The areas under the ROC curves for Bishop score, cervical length, and logistic regression models did not differ significantly (areas ranging from 0.72 to 0.82). If Bishop score was not included in the logistic regression model, cervical length, VI and FI independently predicted delivery > 48 h, the likelihood increasing with increasing cervical length, decreasing VI and increasing FI. Conclusions In prolonged pregnancy cervical vascularization as estimated by 3D power Doppler ultrasound is related to time to delivery > 48 h, but the likelihood of delivery > 48 h can be predicted equally well using Bishop score alone or sonograpbic cervical length alone Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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| 42. |
- Sakse, A., et al.
(author)
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Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle
- 2009
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 34:6, s. 693-698
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Journal article (peer-reviewed)abstract
- Objectives To perform three-dimensional endoanal ultrasound (EA US) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. Methods EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EA US defects were graded according to the Starck score. Results Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1. (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EA US and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores >= 4 had a Starck score of >= 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. Conclusion In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of A I was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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| 43. |
- Saltvedt, S, et al.
(author)
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Screening for Down syndrome based on maternal age or fetal nuchal translucency: a randomized controlled trial in 39572 pregnancies
- 2005
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 25:6, s. 537-545
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Journal article (peer-reviewed)abstract
- Objectives Nuchal translucency (NT) screening increases antenatal detection of Down syndrome (DS) compared to maternal age-based screening. We wanted to determine if a change in policy for prenatal diagnosis would result in fewer babies born with DS. Methods A total of 39572 pregnant women were randomized to a scan at 12-14 gestational weeks including NT screening for DS (12-week group) or to a scan at 15-20 weeks with screening for DS based on maternal age (18-week group). Fetal karyotyping was offered if risk according to NT was >= 1 :250 in the 12-week group and if maternal age was >= 35 years in the 18-week group. Both policies included the offer of karyotyping in cases of fetal anomaly detected at any scan during pregnancy or when there was a history of fetal chromosomal anomaly. The number of babies born with DS and the number of invasive tests for fetal karyotyping were compared. Results Ten babies with DS were born alive with the 12-week policy vs. 16 with the 18-week policy (P = 0.25). More fetuses with DS were spontaneously lost or terminated in the 12-week group (45119 796) than in the 18-week group (27119 776; P = 0.04). All women except one with an antenatal diagnosis of DS at < 22 weeks terminated the pregnancy. For each case of DS detected at < 22 weeks in a living fetus there were 16 invasive tests in the 12-week group vs. 89 in the 18-week group. NT screening detected 71% of cases of DS for a 3.5% test-positive rate whereas maternal age had the potential of detecting 58% for a test-positive rate of 18%. Conclusions The number of newborns with DS differed less than expected between pregnancies that had been screened at 12-14 weeks' gestation by NT compared with those screened at IS-20 weeks by maternal age. One explanation could be that NT screening - because it is performed early in pregnancy - results in the detection and termination of many pregnancies with a fetus with DS that would have resulted in miscarriage without intervention, and also by many cases of DS being detected because of a fetal anomaly seen on an 18-week scan. The major advantage of the 1.2-week scan policy is that many fewer invasive tests for fetal karyotyping are needed per antenatally detected case of DS.
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| 44. |
- Savelli, L., et al.
(author)
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Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii
- 2008
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 32:2, s. 210-219
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Journal article (peer-reviewed)abstract
- Objectives To describe the clinical history and ultrasound findings in women with struma ovarii. Methods Women with a histological diagnosis of struma ovarii who bad undergone preoperative ultrasound examination were identified front the databases of five 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 addition, four authors reviewed all ultrasound images and described them using pattern recognition. Results Of 31 patients identified, 16 bad pure struma ovarii (one malignant), whereas in 15 patients the struma ovarii were 'impure', constituting the major part of a dermoid cyst (all benign, bilateral in one case). Median age was 40 (range, 18-80) years and 22 (71%) patients were of fertile age. Thirteen patients (42%) were asymptomatic, nine (29%) presented with pain, six (19%) with bloating, two (6%) with irregular bleeding and one (3%) with thyreotoxicosis. Most pure struma ovarii (11/16 cases, 69%) contained solid components, but cystic components were always present. The color content at Doppler examination varied front none to abundant. Four patients had ascites. Using pattern recognition the most specific feature of pure struma ovarii was the 'struma pearl', i.e. a smooth roundish solid area, similar, but not identical, to the 'round white ball' seen in dermoid cysts. 'Struma pearls' were present in six cases of Pure struma ovarii. Most (10116, 63%) cases of impure struma ovarii manifested ultrasound features compatible with a dermoid cyst, but six manifested ultrasound features similar to those of pure struma ovarii, 'struma pearls' being seen in three of these. Conclusions The sonographic features of struma ovarii vary. Struma ovarii may be suspected when a 'struma pearl' is seen. Whether 'struma pearls' are indeed a specific ultrasonographic feature of struma ovarii needs to be determined in a prospective study. Copyright (C) 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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| 45. |
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| 46. |
- Simanaviciute, D, et al.
(author)
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Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies
- 2006
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 28:6, s. 794-801
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Journal article (peer-reviewed)abstract
- Objectives To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. Methods Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5(th) percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with pre-eclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. Results Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n = 15) and 46% of the severe (n = 30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. Conclusions Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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| 47. |
- Sladkevicius, Povilas, et al.
(author)
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Contribution of morphological assessment of the vessel tree by three-dimensional ultrasound to a correct diagnosis of malignancy in ovarian masses.
- 2007
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 30:6, s. 874-882
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Journal article (peer-reviewed)abstract
- Objective To determine whether subjective evaluation of the morphology of the vessel tree of ovarian tumors, as depicted by three-dimensional (3D) power Doppler ultrasound, can discriminate between benign and malignant ovarian tumors, and whether it improves characterization compared with using gray-scale ultrasound imaging alone. Methods A consecutive series of 104 women scheduled for surgical removal of an ovarian mass were examined with transvaginal two-dimensional (2D) gray-scale and 3D power Doppler ultrasound. Predetermined vessel characteristics, e.g. density of vessels, branching, caliber changes and tortuosity, were evaluated in 360° rotating 3D images of the vessel tree of the tumor. Ultrasound results were compared with those of the histology of the surgical specimens. Univariate and multivariate logistic regression were used. Results There were 77 benign tumors, six borderline tumors and 21 invasive malignancies. All vascular features differed significantly between benign and malignant tumors. The areas under their receiver-operating characteristics (ROC) curves (AUCs) were in the range 0.61-0.83. The AUC of a logistic regression model containing three gray-scale ultrasound variables was 0.98. This model correctly classified all malignancies, with a false-positive rate of 10% (8/77). Adding branching of vessels in the whole tumor to the gray-scale model yielded an AUC of 0.99 and resulted in all malignancies and an additional four benign tumors being correctly classified. Conclusions Subjective evaluation of the morphology of the vessel tree, as depicted by 3D power Doppler ultrasound, can be used to discriminate between benign and malignant ovarian tumors, but adds little to gray-scale ultrasound imaging in an ordinary population of tumors.
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| 48. |
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| 49. |
- Sladkevicius, Povilas, et al.
(author)
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Ultrasound dating at 12-14 weeks of gestation. A prospective cross-validation of established dating formulae in in-vitro fertilized pregnancies.
- 2005
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 26:5, s. 504-511
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Journal article (peer-reviewed)abstract
- Objectives To determine the accuracy of established ultrasound dating formulae when used at 12-14 weeks of gestation. Methods One-hundred and sixty-seven singleton pregnancies conceived after in-vitro fertilization (IVF) underwent a dating scan at 12-14 weeks of gestation. Gestational age at the dating scan was calculated by adding 14 days to the number of days between the date of oocyte retrieval and the date of the ultrasound scan. Gestational age according to oocyte retrieval was regarded as the true gestational age. True gestational age was compared to gestational age calculated on the basis of 21 dating formulae based on fetal crown-rump length (CRL) measurements and to three dating formulae based on fetal biparietal diameter (BPD) measurements. In a previous study the three BPD formulae tested here had been shown to be superior to four other BPD formulae when used at 12-14 weeks of gestation. The mean of the differences between estimated and true gestational age and their standard deviation (SD) were calculated for each formula. The SD of the differences was assumed to reflect random measurement error. Systematic measurement error was assumed to exist if zero lay outside the mean difference ± 2SE (SE: standard error of the mean). Results The three best CRL formulae were associated with mean (non-systematic) measurement errors of -0.0, -0.1 and -0.3 days, and the SD of the measurement errors of these formulae varied from 2.37 to 2.45. All but two of the remaining CRL formulae were associated with systematic over- or under-estimation of gestational age, and the SDs of their measurement error varied between 2.25 and 4.86 days. Dating formulae using BPD systematically underestimated gestational age by -0.4 to -0.7 days, and the SDs of their measurement errors varied from 1.86 to 2.09. Conclusions We have identified three BPD formulae that are suitable for dating at 12-14 weeks of gestation. They are superior to all 21 CRL formulae tested here, because their random measurement errors were much smaller than those of the three best CRL formulae. The small systematic negative measurement errors associated with the BPD formulae are likely to be clinically unimportant.
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| 50. |
- Sokalska, A, et al.
(author)
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Changes in ultrasound morphology of the uterus and ovaries during the menopausal transition and early postmenopause: a 4-year longitudinal study
- 2008
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In: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 31:2, s. 210-217
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Journal article (peer-reviewed)abstract
- Objectives To describe changes in uterine and ovarian size and morphology as determined by ultrasonography from 2 years before to 2 years after menopause. Methods Twenty 50-year-old women with fairly regular vaginal bleeding at the start of the study underwent transvaginal ultrasound examination every 3 months until 12 months postmenopause, then every 6 months until 24 months postmenopause. The results are presented from 2 years before to 2 years after the menopause. Results In the 2 years preceding menopause all the women were in menopausal transition. From 2 years before to 2 years after menopause uterine anteroposterior diameter decreased by 22% (mean) and left and right ovarian volumes by 45 and 20% (median), respectively. At 2 years before the menopause the total number of intraovarian follicle-like cystic structures varied from 0 to S, at the menopause from 0 to 7, and at I and 2 years after the menopause from 0 to 4 and from 0 to 2, respectively. Premenopause, the most common finding was that of ovaries containing either no follicles or a few follicles with at least one measuring >= 11 mm and simultaneously a hyperechogenic endometrium of varying thickness and not manifesting any midline echo or triple-layer appearance. Images compatible with the late follicular phase were found in 6% (9/150) of examinations ('cycle day' 8-196) and images compatible with the luteal phase in 7% (10/150) ('cycle day' 11-56). Intraovarian cystic structures (3-25 mm) were seen in 14 women after the menopause. Conclusion We have described sonographic changes in the uterus and ovaries occurring during the transition from premenopause to postmenopause.
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