Prenatal sonographic chest and lung measurements for predicting severe pulmonary hypoplasia.

Pulmonary hypoplasia was diagnosed sonographically in 32 fetuses from 20 to 33 weeks of gestation. In addition to standard biometry, transverse thoracic diameter (TTD), sagittal thoracic diameter (TSD), thoracic circumference (TC) and lung diameter (LD) were measured in all cases and compared with known nomograms. The fetuses were divided into five groups according to the main sonographic findings: group 1—skeletal dysplasia; group 2—renal agenesis; group 3—diaphragmatic hernia; group 4—hydrothorax; and group 5—others. Severe pulmonary hypoplasia (PH) was diagnosed prenatally in all cases on the basis of LD measurements. In 17 (53.1 per cent) out of 32 cases TTD was below the 5th percentile…

Ultrasonic mensuration of fetal limb bones in the second and third trimesters

Growth of fetal limb bones has been examined in a prospective cross-sectional study in 530 patients between 13 and 42 weeks of gestation by ultrasound. The length of the femur, tibia, humerus, and radius were measured in all cases, and fibula and ulna in 393 cases. For each week of gestation mean lengths (+/- 2 standard deviations) were calculated. All limb bones showed linear growth from 13 weeks to 25 weeks of gestation, after which the growth curve appeared nonlinear. A strong linear relationship (r greater than 0.98) between the BPD and bone length was found for each bone. In five aborted fetuses, prenatal sonographic measurements of the ossified diaphyses were compared with the postnat…

Prenatal diagnosis of infantile neuronal ceroid-lipofuscinosis: a combined electron microscopic and molecular genetic approach.

Based on two unrelated index patients afflicted with INCL, fetal chorion tissues were studied from subsequent pregnancies of the two respective mothers resulting in the prenatal diagnosis of INCL in two of the three pregnancies. Documentation of INCL was based on electron microscopy and DNA studies of the biopsied chorion tissue, later confirmed in the two affected fetuses after termination of their pregnancies by demonstrating INCL-specific lipopigments in post-mortem tissues, in the liver of both aborted fetuses and, additionally, in spleen and skeletal muscle of one of the affected fetuses. The autolysis of the aborted tissues, however, precluded a systematic documentation of all affecte…

Sonographic size of uterus and ovaries in pre- and postmenopausal women

Uterine and ovarian size were measured in 765 pre- and postmenopausal women by transvaginal ultrasound. Of these, 263 (premenopausal, n = 155; postmenopausal, n = 108) were found to have neither uterine nor ovarian pathological findings. According to parity, premenopausal women were separated into three groups: nullipara, primipara and multipara. Postmenopausal women were separated into two groups according to years since menopause: 5 years since menopause. In the premenopausal group, a parity-related enlargement in uterine size was observed between nulliparous and parous women. After the menopause, a significant reduction in uterine size and in the corpus-cervix ratio was observed. The red…

Application of transvaginal and abdominal three-dimensional ultrasound for the detection or exclusion of malformations of the fetal face

In a total of 618 pregnant women between 9 and 37 weeks' gestation, the fetal face was evaluated by two-dimensional and three-dimensional ultrasound imaging as part of a level III screening evaluation for fetal anomalies. A three-dimensional endovaginal probe (5 MHz) was used for examinations at between 9 and 15 weeks, and an abdominal three-dimensional probe (3.5 MHz) was used after 15 weeks. Three different three-dimensional image display modes were employed: (1) the orthogonal display; (2) the surface display; and (3) the transparent display. When we studied the three-dimensional orthogonal displays in 125 cases evaluated by abdominal ultrasound, we found that the facial profile shown in…

Unruptured tubal pregnancy: local low-dose therapy with methotrexate under transvaginal ultrasonographic guidance.

Thirty patients with unruptured ectopic pregnancy (4-10 weeks' gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development…

Value of the electronic scalpel (cut mode) in the evaluation of the fetal face

Objectives To evaluate the improvement of image quality and diagnostic value of fetal face examinations using the electric scalpel. Methods A total of 232 cases were examined. The fetuses were separated into two groups: Group A, including normal fetuses (n = 152) and Group B, fetuses with facial pathology (n = 80). The fetuses were divided into eight subgroups according to gestational age (9–12 weeks, 13–16 weeks, 17–20 weeks, 21–24 weeks, 25–28 weeks, 29–32 weeks, 33–36 weeks and 37–40 weeks). Results The number of cutting steps for the improvement of image quality ranged from 1 to 9 (mean value 3) in the group of normal fetuses and from 1 to 10 (mean value 3) in the group of fetuses with …

Three-dimensional ultrasonography in prenatal diagnosis

Within the past five years, 3D ultrasonography has developed to the degree that it offers both the patient and the examiner an entirely new visual experience in prenatal diagnosis. With the system described here (Kretz-technik, Austria), any desired plane can be displayed within the stored volume, and within seconds a high-quality 3D surface or transparent image can be calculated and displayed on the ultrasound monitor without need for an external workstation. All of this can be performed routinely in the clinical setting. Since 1989 we have routinely examined a total of 458 fetuses (242 normal and 216 with anomalies) between 16 and 38 weeks of gestation, supplementing our conventional 2D u…

Three-dimensional transvaginal ultrasound in gynecological diagnosis

Volume scanning in the evaluation of fetal malformations: a new dimension in prenatal diagnosis

Three-dimensional ultrasound examination was performed in 204 patients with a fetal malformation detected by conventional ultrasound. The patients were examined between 13 and 40 weeks of gestation. The ultrasound equipment used was a Combison 330 and a Combison 530 (Kretztechnik, Austria) with an abdominal Voluson sector transducer (3.5/5 MHz) (Kretztechnik, Austria). This ultrasound system can provide a high-quality three-dimensional surface or translucency image of fetal structures similar to that of a photograph or an X-ray image within seconds without an additional expensive work-station. Of the 204 patients examined with three-dimensional ultrasound, this technique proved advantageous…

Sonographic diagnosis of lethal osteogenesis imperfecta in the second trimester: case report and review.

EP11.09: Are femur and humerus lengths measured exactly by 3D ultrasound reliable parameters for the detection of Trisomy 21 in the second trimester?

Ovarian Endometrioid-like Yolk Sac Tumor Treated by Surgery Alone, with Recurrence at 12 Years

Abstract We describe the case of a stage Ia endometrioid-like yolk sac tumor (YST) of the ovary, which was originally misdiagnosed as a malignant struma ovarii and not treated with adjuvant chemotherapy. After 12 years, a contralateral dermoid cyst was excised along with a small omental nodule of partially necrotic and calcified endometrioid-like YST. No tumor was detected in several other biopsy specimens, and a peritoneal lavage was negative for tumor cells. Since there was no evidence of remaining tumor and the serum α-fetoprotein (AFP) level was normal after the second operation, the patient was followed. Serial serum AFP levels remained normal for 4 months. At a second-look laparotomy …

Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies

Objectives It was the aim of the present study to calculate new Doppler reference ranges for blood flow velocities (Vmax, Vmean, Vmin) and resistance indices (PI, RI) for the fetal descending aorta by automatic waveform analysis. Design Cross-sectional prospective study. Subjects Nine hundred and twenty-six low-risk pregnancies at 18–41 weeks' gestation. Methods Aortic blood flow velocities were derived with pulsed-wave color Doppler. Measurements were carried out at the level of the diaphragm. Reference ranges for the individual measuring parameters were constructed based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square pri…

Biometry of the fetal corpus callosum by three-dimensional ultrasound

Objectives To construct reference ranges of quantitative characteristics of the fetal corpus callosum. Methods Women referred to a tertiary center for sonographic examination were recruited to undergo a detailed fetal scan from 17 to 41 weeks of gestation. Three-dimensional (3D) sonographic volumes of normal fetal brains were acquired and analyzed offline. We obtained three different measurements of the corpus callosal length, as well as the height (/thickness) of its segments, namely the rostrum, genu, body and splenium. Results Initially we recruited 604 pregnant women, of whom 138 were excluded because of various disorders/abnormalities, multiple pregnancy or gestational age < 18 weeks. …

Mathematical modeling of fetal limb growth

Using ultrasound measurements of the femur, tibia, humerus, radius (N = 515), and fibula and ulna (N = 385) from normal fetuses between 12 and 40 completed weeks of gestation, growth models were determined for each bone by computer analysis. On the basis of residual analysis, growth of fetal limb bones could best be expressed as a function of tangens hyperbolicus. Growth profiles and growth data are shown with 5th, 10th, 50th, 90th, and 95th percentiles. These results are compared with previous investigations of limb bone measurements.

Three Dimensional ultrasound - a requirement for prenatal diagnosis?

Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma

In recent years, the incidence of carcinoma of the endometrium has shown an upward trend, such that it is currently the most frequently encountered malignant tumor of the female genital tract. An accurate preoperative diagnosis of the extent and spread of such carcinomas is of crucial importance for the selection of a therapeutic approach appropriate to the stage and infiltration of each particular tumor. In a prospective study of 80 patients with a carcinoma of the endometrium, performed at the Department of Obstetrics and Gynecology of the University of Mainz, we compared the preoperative findings of transvaginal sonography with the postoperative histological results with respect to the f…

Minimal invasive Therapie bei peritonealer Leiomyomatose

Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease characterised by the presence of multiple intraabdominal nodules, consisting of benign smooth muscle. LPD has only been found in women, predominantly in their late reproductive age. There is a very high association with excess exogenous and endogenous female gonadal steroids, specifically oestrogen and progesterone. Since it is grossly indistinguishable from diffuse carcinomatosis of the peritoneum, several unnecessary radical procedures have resulted. We describe the 44th documented case and the first case of minimal invasive surgery in a 42-year-old women with peritoneal leiomyoma on the right pelvic wall and uterine s…

F75Determining fetal lung volume using three-dimensional-ultrasonography

Background The aim of the study was to establish fetal lung, thoracic and heart volume nomograms using 3D-ultrasonography. Method For this purpose 115 fetuses were examined (between 18 and 33 weeks of gestation) using Voluson 530D (Kretztechnik, Austria) ultrasound device and 5 MHZ three-dimensional annular volume transducer. Lung volumes of 15 fetuses suffering from skeletal dysplasia, renal agenesis or hydrothorax and secondary pulmonary hypoplasia were compared with previously established nomograms. Results Lung volumes in the pathologic group of fetuses compared to the nomograms were below the 5% for gestational age. Conclusion The encouraging first results suggest that this method coul…

Age-Related Reference Ranges for Fetal Foot Length

AIM The aim of this study was to establish age-dependent reference ranges for fetal foot length with gestation as well as for the femur/foot length ratio, based on a mathematical growth model. METHOD In a prospective cross-sectional study of 610 pregnancies with sonographically confirmed gestational age (< 12 weeks' gestation), fetal biometry was performed in addition to measurements of fetal foot length between 12 and 42 completed weeks of gestation. Reference ranges for the fetal foot and for the femur/foot length ratio were constructed with an overall coverage of 90% of the measured data, using a previously established method of determining reference bands for growth parameters. RESULTS …

Fetal presentation of Morquio disease type A.

A fetus with mucopolysaccharidosis type IV A (Morquio type A) is described. The family had one affected child exhibiting symptoms of classical Morquio A disease, and late in the subsequent pregnancy prenatal diagnosis was requested. At 23 weeks' gestation, moderate ascites was detected by detailed ultrasound scan and keratan sulphate was found in the amniotic fluid. The pregnancy was terminated by prostaglandin induction and the diagnosis of mucopolysaccharidosis type IV A was confirmed by demonstration of a deficiency of N-acetylgalactosamine-6-sulphate (GalNac-6-S) sulphatase in cultured amniotic cells and in post-mortem fibroblast cultures. The activities of beta-galactosidase and arylsu…

Familial fatal fetal cardiomyopathy with isolated myocardial calcifications: A new syndrome?

We describe three male sib fetuses with isolated myocardial calcifications resulting in intrauterine fetal death (IUFD) as early as the second trimester. No evidence for an underlying mitochondrial cytopathy, dystrophinopathy or myopathy was found. There were no signs of inflammation or a metabolic disorder, and the mother had no prenatal exposure of teratogenic drugs. Furthermore, no mutation in the Barth syndrome gene (G4.5) could be detected. Because isolated calcification of the heart and IUFD are not typical of any previously described inherited cardiomyopathy, it may represent a new familial fetal cardiomyopathy.