The assessment of human life from conception to implantation by transvaginal color Doppler.
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Corpus Luteum↗
Biomedical subjects
S Kupesic
Publications and source records attributed to S Kupesic.
Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal.
Transvaginal color Doppler ultrasonography was used to study 131 normal early pregnancies, 30 molar pregnancies, 20 threatened abortions, two blighted ova, and five pregnancies with intramural myoma. Four separate parts of the maternal circulation were studied: uterine, arcuate, radial, and spiral arteries. There was statistical difference in the RI and PI among uterine, arcuate, radial, and spiral arteries (P < 0.001) in all observed groups of patients except those with intramural myoma. When the same part of the maternal circulation was compared among different groups of patients, the following results reached statistical significance: uterine artery in normal and molar pregnancy (P < 0.001); arcuate artery in normal and molar pregnancy (P < 0.001); radial artery in normal and molar pregnancy (P < 0.001) and in normal pregnancy and threatened abortion (P < 0.01); spiral artery in normal and molar pregnancy (P < 0.001), in normal pregnancy and threatened abortion (P < 0.01), and in molar pregnancy and threatened abortion (P < 0.01). The standard values of blood flow are different in normal and in some cases of abnormal early pregnancy (molar pregnancy, threatened abortion).
Abortion, Threatened↗
Fetal choroid plexus vascularization assessed by color flow ultrasonography.
We investigated the development of intracranial vascularization in the human fetus, with particular emphasis on the choroid plexus. The fetal brain was visualized in 102 patients with healthy pregnancies between 9 and 16 weeks' gestation. Imaging was done transvaginally except in the pregnancies of longer duration with unfavorable fetal positions. Color flow imaging was used to identify vessels in the cranium and within the choroid plexus. Pulsed Doppler signals were obtained from an internal carotid-middle cerebral artery and from a choroid plexus vessel. The pulsatility index was calculated from the Doppler spectral envelope. A major cerebral vessel could be seen at 9 weeks' gestation. Choroid plexus vessels were first seen at 10 weeks 3 days. Visualization rates ranged from 35 to 75% for plexus vessels, and 65 to 100% for cerebral vessels. Visualization of choroid plexus vessels was maximal at 13 weeks. The pulsatility index for the cerebral arteries at this gestational period averaged 2.6 +/- 0.6. The result for the choroid plexus was 1.66 +/- 0.5. (P < 0.001). Visualization of the vessels of the choroid plexus increases and decreases as the gland develops and shrinks. This developmental period also is the time of active neurogenesis.
Adult↗
An attempt to screen asymptomatic women for ovarian and endometrial cancer with transvaginal color and pulsed Doppler sonography.
Several screening procedures have been proposed to detect ovarian and endometrial cancer. However, none of them is sensitive and specific enough to be used in population-based screening programs. During our 5 year long study, 5013 asymptomatic women (44% premenopausal and 56% postmenopausal women) were scanned by transvaginal color and pulsed Doppler ultrasonography in an attempt to detect malignancy. These women had 404 adnexal cysts; 70 had resolved spontaneously on follow-up scans and 18 persisted. Another 316 sonographically benign cysts are still in the procedure of follow-up second scans. Of 5013 women, four women had stage I ovarian carcinoma and six had stage I endometrial carcinoma. There was one false-positive case encountered with an endometrioma. Only 14 women were subjected to major operative intervention; others underwent minor procedures based on the benign scan findings. No medical or surgical complications were reported. Transvaginal color Doppler ultrasonography, a noninvasive procedure, can detect ovarian and endometrial carcinoma in asymptomatic women and may be used as a screening procedure for these diseases.
Endometrial Neoplasms↗
Doppler ultrasound in all three trimesters of pregnancy.
Doppler ultrasound velocimetry of uteroplacental, umbilical, and fetal vessels provides the clinician with important information on the hemodynamics of the vascular area under study. Transvaginal color Doppler is a new technique that allows precise investigation of fetomaternal circulation in early pregnancy. Doppler can be used to follow physiologic hemodynamic changes in uteroplacental and fetal vessels in this period of gestation, and to measure circulatory disturbances in some pathologic conditions. In late pregnancy, Doppler is a useful diagnostic tool for monitoring fetuses with intrauterine growth retardation. Doppler is a better predictor of perinatal morbidity than other methods of fetal surveillance. Recent investigations have shown that fetal vein flow affects fetal wellbeing. Randomized control trials have given different answers about the cost-effectiveness of Doppler in obstetrics.
Female↗
Transvaginal color Doppler sonography in the assessment of pelvic tumor vascularity.
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Journal Article↗
Endometrial carcinoma in postmenopausal women: evaluation by transvaginal color Doppler ultrasonography.
OBJECTIVE: This study was conducted to evaluate the role of transvaginal color Doppler ultrasonography in detecting endometrial carcinoma in postmenopausal women and in evaluating the depth of myometrial invasion and tumor staging. STUDY DESIGN: A group of 750 postmenopausal women were examined by transvaginal color Doppler ultrasonography 1 day before the planned hysterectomy. Histopathologic and blood flow characteristics were evaluated. Analysis of variance was used to test the significance among the subgroups. RESULTS: Thirty-five women had endometrial carcinoma; 32 (91.4%) cases were detected by transvaginal color Doppler ultrasonography. Visualization of abnormal blood flow within the endometrium was 100% in the diagnosed cases with resistance index near or < 0.40, which constituted a statistically significant difference compared with that of endometrial hyperplasia. No flow was detected in normal, atrophic, and in 92% of cases with hyperplastic endometria. The color Doppler ultrasonography depicted 18 of 19 histologically proved cases of myometrial invasion. Three asymptomatic cases were discovered on the basis of morphologic and blood flow patterns. CONCLUSION: Transvaginal color Doppler ultrasonography can depict endometrial carcinoma, even in asymptomatic women, determine the depth of myometrial invasion, and help in tumor staging.
Endometrial Neoplasms↗
Uterine and ovarian perfusion during the periovulatory period assessed by transvaginal color Doppler.
OBJECTIVE: To measure the flow velocity of the uterine, radial, spiral, and ovarian arteries during the periovulatory period in spontaneous and induced ovarian cycles with confirmed ovulation. DESIGN: Daily measurements during the periovulatory period in 78 patients attending an infertility clinic because of the male factor in infertility. RESULTS: Uterine flow velocity in spontaneous cycles has a pulsatility index (PI) of 3.16 2 days before ovulation and starts to decrease the day before ovulation (PI = 2.22). In stimulated cycles these changes do not occur, and mean PI of 3.06 remains at that level during the periovulatory period. Clear flow velocity waveforms are obtained from the endometrium and myometrium around the time of ovulation. Data obtained from the radial arteries suggest better myometrial perfusion in patients with natural cycles. Spiral artery flow velocity in spontaneous cycles has a PI of 1.13 the day before ovulation and a nadir of 0.72 is reached the day after ovulation. On the contrary, the mean PI of the spiral artery blood flow in the group with ovulation induction rises during the day before ovulation (PI = 2.32) and reaches a nadir of 1.09 the day after ovulation. CONCLUSIONS: These data suggest the presence of better uterine receptivity during the periovulatory phase of natural cycles compared with induced ovarian cycles. Endometrial perfusion presents accurate noninvasive assay of uterine receptivity that may be used to predict implantation success rate, to reveal unexplained infertility problems, and to select patients for correction of endometrial perfusion abnormalities by an appropriate treatment.
Blood Flow Velocity↗
Recent advances in the Doppler study of early fetomaternal circulation.
Transvaginal color Doppler has enabled precise investigation of feto-maternal circulation in early pregnancy. Decrease of peripheral impedance, as well as increase of blood flow velocity was found in all segments of the uteroplacental circulation with gestational age. The same finding was observed in umbilical artery, fetal aorta and intracranial blood vessels. A significant decrease of vascular impedance in cerebral blood vessels exists earlier than in fetal aorta or umbilical artery which could be explained by the establishment of cerebral autoregulation mechanisms which ensure adequate oxygen and glucose supply to embryonic brain. There was no significant difference for RI values of luteal blood flow from the 6th to the 12th gestational week. No difference was found between RI values of luteal blood flow in normal and ectopic pregnancy. In threatened, incomplete and missed abortions RI of luteal blood flow was significantly higher in comparison with normal pregnancy. It seems that in the group of patients with threatened abortion, follow up of the luteal flow might give some prognostic value. No difference in peripheral impedance and blood flow velocity of the uteroplacental blood vessels was found between women with normal pregnancies and women with threatened abortions and normal pregnancy outcome. There was no significant difference in terms of RI and PSV in uteroplacental blood vessels between women with threatened abortion and normal pregnancy outcome and women with threatened abortion whose pregnancy terminated with complete abortion and blighted ovum. In 46% of 21 women with visible retrochorionic hematoma RI in spiral arteries was higher and PSV was lower on the side of the hematoma. These values could be explained by compression of the wall of the spiral arteries caused by hematoma. In missed abortion the mean RI value of the uterine artery was lower than the mean value in normal pregnancy, but was not in spiral arteries. Some authors reported RI values in cases of missed abortions around and above the cutoff point value of 0.63. In blighted ovum RI in uterine and spiral arteries was lower in comparison to normal pregnancy, but in the other studies this was not the case. Increased blood flow in radial arteries in patients with pregnancy associated with uterine myomata could be explained by higher levels of estriol hormone metabolized in the placenta. Transvaginal color Doppler could be helpful in diagnosis and differentiation of the different forms of a gestational trophoblastic disease. It seems that this technique is a good substitute for pelvic angiography.(ABSTRACT TRUNCATED AT 400 WORDS)
Abortion, Spontaneous↗
Preoperative evaluation of cystic teratoma: what does color Doppler add?
The aim of this prospective study lasting 4 years was to develop a scoring system using clinical parameters, sonographic findings, and transvaginal color and pulsed Doppler impedance values for the preoperative recognition of cystic teratoma. A total of 887 benign and malignant adnexal masses, among which 102 were histologically proved to be cystic teratomas, were evaluated. Using morphological criteria, cystic teratoma was successfully predicted in 95 patients. The sensitivity and specificity of a morphological scoring system were 93.1% and 99.4%, respectively, while positive and negative predictive values were 95.0% and 99.1%. A scoring system using both morphology and vascular assessment demonstrated higher sensitivity and specificity (99.02%, 99.75%). The application of a scoring system combining morphology and vascularity improves the accuracy of diagnosing cystic teratoma and of separating this entity preoperatively from other benign and malignant ovarian conditions.
Adnexa Uteri↗
Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns.
A case control study of 59 women with subchorionic hematomas compared to 135 normally pregnant. Transvaginal ultrasound was used to image the pregnancy, and identify the site and size of the hematomas. Color flow Doppler was used to calculate velocity indices of the spiral arteries. More spontaneous abortions occurred in women with subchorionic hematomas (SCH). There was general correlation between gestational age, velocity indices, and hematoma size. There were 10 spontaneous abortions in the study group (17%) versus 9 (6.5%) in the controls (P = 0.02). Hematoma size did not affect outcome, but site did. Most hematomas associated with abortion were found in the corpus or fundus of the uterus, not in the supracervical area (P = 0.03). The presence of a hematoma did not affect the frequency of preterm delivery. In conclusion, subchorionic hematomas in early pregnancy are associated with an increased risk of spontaneous abortion. Flow disturbances are seen in the spiral arteries, but these are probably secondary effects. The critical factor is site of hematoma, not volume.
Abortion, Spontaneous↗
Early ovarian cancer: 3-D power Doppler.
Transvaginal sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging and pulsed Doppler spectral analysis enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitative measurement of blood flow velocity waveforms. These parameters increase the sensitivity and specificity of ultrasound evaluation of ovarian tumors. Unfortunately, there is no consensus as to which Doppler parameters and cutoff values are the most predictive of malignancy. Three-dimensional (3-D) power Doppler ultrasound provides a new tool to evaluate features of tumor vascularity. Three-dimensional ultrasound and 3-D power Doppler imaging in patients with "positive" findings on standard ultrasound tests, which encompass annual gray-scale transvaginal sonography followed by transvaginal color Doppler ultrasound in selected cases, represent a novel approach for early and accurate detection of ovarian cancer through screening. Combined evaluations of morphology and neovascularity by 3-D power Doppler ultrasound may improve early detection of ovarian carcinoma. Contrast-enhanced 3-D power Doppler sonography facilitates visualization of adnexal tumor vessels, which may aid in differentiating benign from malignant adnexal lesions.
Contrast Media↗
Doppler evidence of intervillous circulation during the first trimester of pregnancy.
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Adult↗
Assessment of the fetomaternal circulation in threatened abortion by transvaginal color Doppler.
Transvaginal color Doppler was used to investigate blood flow in the fetomaternal circulation of 60 women with threatened abortion and 90 women with normal intrauterine pregnancy. The obtained Doppler sonograms were analyzed and the resistance index (RI) was calculated in the maternal circulation, while in the fetal circulation the pulsatility index (PI) was used. There was no significant difference in the RI values of the maternal circulation between women with normal pregnancies and pregnancies complicated by bleeding, but with normal pregnancy outcome (p > 0.05). No differences in RI values of the uterine, arcuate and radial arteries were found between pregnancies with threatened abortion and normal pregnancy outcome and women with abnormal outcome (p > 0.05). In 9 of 21 women with visible retrochorionic hematoma, the RI of the spiral arteries was higher on the hematoma side in comparison to the opposite side (p < 0.01). This could be a consequence of the mechanical compression caused by the hematoma. In 3 of 4 cases of missed abortion, the RI of the spiral arteries was lower in comparison to the control group. Such findings could be caused by the vasodilatating products of inflammation which probably exist in such areas. There was no significant difference in terms of the PI of fetal blood vessels between normal pregnancy and threatened abortions with normal outcome, as well as between threatened abortions with normal outcome and subsequent abortions of live fetuses (p > 0.05).
Abortion, Threatened↗
Three-dimensional sonography for assessment of morphology and vascularization of the fetus and placenta.
OBJECTIVE: To analyze the potential of three-dimensional power Doppler sonography in morphologic and functional assessment of the fetus and placenta. METHODS: Review of the recent literature on three-dimensional sonography in early pregnancy and in the second and third trimester. RESULTS: Three-dimensional sonography plays an important role in obstetrics predominantly for assessing fetal anatomy. Multiplanar images and rotation of the object allow systematic review of anatomic structures, such as limb buds, cerebral cavities, cord insertion, stomach, and bladder. Using this modality, volumes of the gestational sac, yolk sac, and fetal organs can be obtained easily. Three-dimensional power Doppler sonography has the potential to study the intervillous and placental circulation and evaluate the development of the embryonic and fetal cardiovascular system. CONCLUSIONS: Three-dimensional ultrasound imaging complements pathologic and histologic evaluation of the developing embryo, giving rise to the new term "three-dimensional sonoembryology." It is evident that three-dimensional ultrasonography improves the visualization of the normal and abnormal fetal anatomy giving a realistic impression of the extent of the defects. These data are useful not only for obstetricians but also for pediatricians and pediatric surgeons.
Congenital Abnormalities↗