Internet: personal use by obstetric and gynecological sonologists.
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Data Collection↗
Biomedical subjects
S Degani
Publications and source records attributed to S Degani.
Fetal cardiac measurements derived by transvaginal and transabdominal cross-sectional echocardiography from 14 weeks of gestation to term.
OBJECTIVE: Most of the routine ultrasound screening in our institution consists of early transvaginal examinations at 14-17 weeks. Complete fetal echocardiography is performed in every case. However, normal values for most fetal cardiac structures at this stage of gestation are not available. Our aim was to construct normal ranges for fetal cardiac structures, derived from cross-sectional echocardiography, at 14-40 weeks of gestation. DESIGN: A prospective study was performed. The study group consisted of 637 pregnant women referred for a routine sonographic examination. Women with abnormal prenatal or postnatal outcome were not included in the study. Transvaginal examinations were used for 14-17 weeks of gestation. More advanced pregnancies were examined transabdominally. RESULTS: We constructed normal ranges for the left and right end-diastolic transverse ventricular diameters (n = 637), left/right ventricular ratio (n = 637), aortic root diameter (n = 637), pulmonary artery diameter (n = 637), aortic/pulmonary ratio (n = 490), left and right transverse atrial diameters (n = 201) and left/right atrial ratio (n = 201). CONCLUSIONS: The results provide the examiner with normal ranges for fetal cardiac structures for the early transvaginal examination. The continuity of all curves from 14 to 40 weeks of gestation allows follow-up of any specific fetus to term.
Aorta↗
Endometrium-to-myometrium relative echogenicity coefficient. A new sonographic approach for the quantitative assessment of endometrial echogenicity.
A computer program was developed to assess the endometrial echogenicity relative to the myometrial one, based on the gray-level processing of the midsagittal uterine image. The endometrial region of interest was specified within the upper part of the uterine cavity. The adjacent area of the myometrium was used to determine the reference brightness. The endometrial region of interest was analyzed along the anteroposterior uterine axis, as a set of thin strips directed parallelly to the midcavitary line. The endometrial/myometrial relative echogenicity coefficient (E/M REC) was computed for each strip and displayed graphically as a function of the distance from the midcavitary line. The area under the E/M REC curve within the limits of the total endometrial width was defined as total area (TA) and was used as a measure of the endometrial echogenicity. This parameter was assessed in 9 patients during their normal ovulatory cycles and in 29 IVF-treated patients with mechanical infertility. TA has a significant linear increase during the days of the ovulatory cycles. TA was found in high correlation with log(estradiol). TA can be used reliably for sonographic endometrial dating in ovulatory cycles.
Endometrium↗
Myometrial thickness in pregnancy: longitudinal sonographic study.
The purpose of this study was to evaluate in vivo the changes in myometrial thickness throughout pregnancy. Myometrial thickness was measured in 25 singleton uncomplicated pregnancies. Ultrasonographic sagittal and transverse sections were used to measure uterine wall thickness from the low anterior wall (lower segment) and the anterior, posterior, right, and left walls of the upper segment and from the fundus. In each case four measurements were made in the second and third trimesters. Myometrial thickness of the upper uterine segment remains fairly constant in the first and second trimesters of pregnancy, whereas a significant linear trend was found between a decreasing thickness of the lower uterine segment and advancing gestational age. Myometrial thickness is significantly increased behind the placental insertion site as compared to other portions of the uterine wall. These data may serve as baseline reference values for further studies in the antepartum fetal surveillance of high-risk pregnancies.
Adult↗
Differences between Twin Umbilical Coiling Indices Correlate to Differences in Twin Weight and Doppler Indices.
> Objective: The aim of our study was to evaluate sonographic and Doppler detectable differences in umbilical coiling index and fetoplacental circulation of discordant twins. Study Design: Doppler blood flow studies in 13 pairs of concordant and 20 pairs of discordant twins were performed from umbilical artery, middle cerebral artery, inferior vena cava, and ductus venosus. Flow studies were compared and correlated with the antenatal sonographic coiling index and the actual umbilical cord length, number of vascular helices, and birth weight. All studies were performed within 72 h before delivery. Pulsatility index (PI) values were calculated for the arteries and preload index (PLI) values for the veins. The umbilical coiling index (CI) was calculated using sonographic longitudinal views of cord vessels from several segments antenatally and by dividing the total number of helices by cord length (cm) postnatally. Discordancy was defined as a more than 20% intrapair actual birth weight difference. For all these index values the intertwin differences (Delta values) were calculated by subtracting the values obtained in the larger twin with those of the smaller twin. Results: The mean +/- SD intertwin difference in umbilical coiling index was 27.4 +/- 10.5% in the antepartum period and 28.9 +/- 10.0% after birth. Regression analysis showed a significant linear trend (r = 0.77, P < 0.001) between intertwin birth weight difference (DeltaBW) and intertwin coiling index difference (DeltaCI). A good correlation was found between DeltaCI and DeltaPLI in the ductus venosus (r = 0.63, P < 0.05), DeltaPLI in the inferior vena cava (r = 0.51, P < 0.005), and DeltaPI in the middle cerebral artery (r = 0.44, P < 0.05). Conclusions: Intertwin difference in antepartum umbilical coiling index can be determined by ultrasound and correlates well with: 1) the actual difference in coiling indices at birth, 2) the intertwin birth weight difference and 3) the intertwin Doppler flow characteristics in the fetal cerebral and venous circulation.
Journal Article↗
Risk of wrist injury from repetitive use of ultrasound transducers.
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Allied Health Personnel↗
Fetal pyelectasis in consecutive pregnancies: a possible genetic predisposition.
Mild fetal pyelectasis is a relatively common finding. The objective of this study was to assess its recurrence rate in subsequent pregnancies. The study comprised 420 women with two consecutive normal uncomplicated pregnancies screened at 15-24 weeks' gestation by ultrasound. Pyelectasis was defined as a fetal pelvis of 4 mm or more in its anterior-posterior dimensions. Of 64 fetuses with pyelectasis, 43 (67%) had a recurrence of this finding in their subsequent pregnancy. Compared with normal fetuses, those with pyelectasis had a relative risk of 6.1 to have a recurrence of this finding in their next pregnancy (95% confidence interval, 4.3-7.5, p < 0.001). These results suggest a predisposition for pyelectusis that may be influenced by genetic and/or environmental factors. More data are needed before an accurate adjustment based on previous results can be made.
Adult↗
Accurate diagnosis of postabortal placental remnant by sonohysterography and color Doppler sonographic studies.
The decision whether to perform uterine curettage for postabortal bleeding depends on the ability to demonstrate placental remnants in the uterine cavity. However, diagnosis of postabortal trophoblastic residua by conventional ultrasonography may be inconclusive. We report our experience with the use of combined sonohysterography and color Doppler to demonstrate a placental polyp after early pregnancy termination.
Abortion, Induced↗
Sonographic evaluation of the uterus in postmenopausal women receiving tamoxifen: characterization of mid-uterine abnormalities.
BACKGROUND: Tamoxifen is known to exert agonist estrogenic effects on the uterus. Its use in postmenopausal women has also been associated with various endometrial and uterine abnormalities that can be detected by endovaginal sonography. OBJECTIVE: To study postmenopausal patients receiving tamoxifen who were referred for evaluation following the detection of abnormal uterine findings by endovaginal sonography. METHODS: Fifty-two women treated with tamoxifen for breast cancer who were found to have an abnormal uterine sonogram constituted the study population. Uterine sonograms were reviewed and clinical and sonographic data were correlated with the results of the histologic examinations. RESULTS: Forty-five women demonstrated a thickened mid-uterine structure. Of these, in thirty-nine patients (87%) either no tissue of scant fragments of normal endometrium were obtained on curettage, and six women (13%) had endometrial hyperplasia. Seven women had fluid loculation lined by thin endometrium. Their subsequent histologic examination was normal. The sonograms of the women who demonstrated an appearance of a thickened endometrium but no neoplasia, characteristically demonstrated hyperechogenic cystic area with no midline echo. CONCLUSIONS: Among 52 postmenopausal patients receiving tamoxifen presented with an abnormal uterine sonogram, 39 (75%) women were found to have a thick mid-uterine structure resembling a thickened endometrium without histologic evidence of neoplasia. This phenomenon can be characterized by typical sonographic features, and may be differentiated from other uterine abnormalities.
Adult↗
The effect of maternal prostaglandin administration on fetal ductus venosus blood flow velocity.
Our objective was to investigate whether maternal administration of prostaglandins PGE2 and PGF2(alpha) is associated with changes in fetal ductus venosus flow velocity waveforms. Second-trimester termination of pregnancy was induced in 11 women (group A) by intra-amniotic instillation of 40 mg PGF2(alpha). In group B, 19 patients received 0.5 mg PGE2 intracervically for preinduction cervical ripening. Doppler flow velocity waveforms were recorded from the fetal ductus venosus immediately before and 40-60 min after prostaglandin administration. The paired t-test was used for statistical analysis of the ductus venosus index (DVI). The mean DVI decreased after PGF2(alpha) administration from 0.62 +/- 0.12 to 0.52 +/- 0.13 (p < 0.01); and from 0.62 +/- 0.10 to 0.58 +/- 0.12 (p < 0.05) after PGE2 administration. Atrial peak velocities were significantly increased after the procedures. No significant changes were found for systolic peak velocity values. The data indicate that major changes in ductus venosus hemodynamics are induced by PGF2(alpha) and PGE2.
Abortion, Therapeutic↗
The antenatal diagnosis of fetal atrial septal aneurysm.
Fetal atrial septal aneurysm (ASA) is uncommon and little is known regarding its prevalence and clinical significance. In this report we describe 2 cases of fetal ASA diagnosed by ultrasonography. They were referred for examination because of fetal tachyarrhythmia in 1 case, and polyhydramnios in the other. The first case had a normal outcome, while the other was associated with other congenital heart malformations. The literature as regards the diagnosis, prevalence, pathology, and clinical implications of ASA is discussed.
Adult↗
The karyotype of fetuses with anomalies detected by second trimester ultrasonography.
OBJECTIVE: To determine the incidence of abnormal karyotype among fetuses with anomalies detected by detailed second trimester ultrasonography. STUDY DESIGN: A total of 573 patients underwent amniocentesis following the detection of anomalies by detailed second trimester ultrasonography. RESULTS: Thirty-six (6.3%) fetuses with abnormal karyotype were detected. The most common abnormal karyotypes were: trisomy 18, 11 cases; trisomy 21, 8 cases; 45XO, 7 cases; trisomy 13, 3 cases; and triploidy, 2 cases. Abnormal karyotype was detected in 20/111 (18%) fetuses with more than one anomaly, 15/182 (8.2%) with cystic hygroma, and 1/38 with nuchal thickening. No abnormal karyotype was detected among 108 fetuses with choroid plexus cyst, 58 with hydronephrosis, 25 with ventriculomegaly, 16 with a single umbilical artery, 18 with cardiac anomalies. CONCLUSIONS: (1) Half of the cases with abnormal karyotype occurred in fetuses with more than one anomaly. (2) Cystic hygroma was the isolated malformations most commonly associated with abnormal karyotype. (3) Isolated malformations such as choroid plexus cyst or hydronephrosis were not associated with abnormal karyotype.
Chromosome Aberrations↗
Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics.
OBJECTIVE: To quantitate umbilical vascular coiling antenatally, and to correlate the coiling index with Doppler flow characteristics in umbilical vessels. METHODS: We studied 45 normal term fetuses within 24 hours before delivery. The umbilical coiling index was calculated using sonographic longitudinal views of cord vessels from several segments antenatally, and by dividing the total number of helices by the cord length (in centimeters) postnatally. Doppler flow velocities were obtained from umbilical arteries and vein in each cord. Flow characteristics were correlated with the umbilical coiling index. RESULTS: The mean (+/- standard deviation) umbilical coiling index was 0.44 +/- 0.11 in the antepartum period and 0.28 +/- 0.08 after birth. Regression analysis showed a significant linear trend (r = 0.71, P < .001). The correlations between sonographic coiling index and umbilical arterial Doppler flow characteristics (mean velocity, pulsatility index, resistance index, and systolic-diastolic ratio) were not significant. The sonographic coiling index was related to time-averaged velocity and flow in the umbilical vein. A good correlation was found between umbilical vein flow and the coiling index, with a significant linear trend (r = 0.59, P < .001). CONCLUSION: An intrauterine umbilical coiling index can be determined by ultrasound and correlates well with the actual index at birth. The sonographic umbilical coiling index is related to Doppler flow characteristics in the umbilical vein.
Female↗
In utero sonographic appearance of intestinal duplication cysts.
The antenatal appearance of gastrointestinal duplication cysts is described. Two cases are presented: a duplication cyst of the pylorus and a cyst of the terminal ileum. The embryogenesis and the clinical utility of prenatal diagnosis of these malformations of the alimentary tract are discussed. Antenatal detection of these cystic masses allowed close neonatal surveillance and timely surgical intervention prior to neonatal complications.
Adult↗
Subendometrial myometrial contractions associated with transcervical chorionic villous sampling.
Thirty-two consecutive patients, referred for prenatal diagnosis by chorionic villous sampling, were examined by transvaginal ultrasound for the presence of myometrial contractions before and after the procedure. Increased myometrial activity was observed in 78% of patients. The mean frequency increased by 3.5 times and the amplitude increased by 4.2 times compared to the preprocedure condition. Cramping was associated with the increased amplitude and/or frequency of contractions. No significant correlation was found between the direction of propagation of the contraction wave and its frequency or amplitude. The sensitivity of ultrasonographically detected myometrial contractions in predicting cramping is 70%, but only 31% in predicting vaginal bleeding or spotting. Further studies are required to elucidate the prognostic significance of this uterine activity.
Adult↗
Doppler studies of fetal cerebral blood flow.
Doppler flow velocity waveforms from fetal cerebral vessels can be reliably obtained by a transabdominal or transvaginal scanning route. Changes in pulsatility imply alterations in cerebral impedance and reflect the physiological regulatory mechanisms underlying pathological processes during pregnancy. In fetuses severely distressed due to failure of placental function, the ratios reflecting the redistribution of fetal circulation (e.g. the 'brain-sparing effect') help to identify fetuses at risk for fetal hypoxia. Apart from providing an increase in medical knowledge, this non-invasive technique is proving to be clinically useful.
Journal Article↗
[Fetal anti-arrhythmic therapy].
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Anti-Arrhythmia Agents↗
Intracervical prostaglandin E2 for induction of labor in patients with premature rupture of membranes and an unripe cervix.
The efficacy and safety of intracervical prostaglandin E2 (PGE2) gel for induction of labor in patients with premature rupture of the membranes (PROM) at term and with an unripe cervix were evaluated. Fifty-two patients who did not start labor 6 to 12 hours after PROM and who had an unripe cervix were randomized to one of two management protocols. Patients randomized to PGE2 received a single intracervical application of 0.5 mg PGE2. Patients randomized to the conservative protocol were managed expectantly for 24 hours. If labor was not established 6 hours after randomization in patients receiving PGE2 or 24 hours after PROM in patients managed expectantly, labor was induced with intravenous oxytocin. Of the patients receiving PGE2, 93% began labor after a single application, and the mean interval between prostaglandin application and delivery was 6.6 hours. In the conservative group, only 57% began labor within 24 hours, and more than half of them required augmentation with oxytocin. The mean latency between PROM and delivery was 15 hours in patients managed with PGE2 and 30 hours in patients managed conservatively (P < 0.01). There were no complications and pregnancy outcome was similar in the two groups. Intracervical PGE2 is safe and effective for inducing labor in patients with PROM and an unfavorable cervix.
Adult↗