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Objective To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease. Setting Tertiary care center. Population Experienced and less experienced midwives performing ultrasound scans. Methods Number of fetuses and live-born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound. Main outcome measures The prenatal detection rate of complex congenital heart malformations. Results The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p < 0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p < 0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared with results achieved by their more experienced colleagues before the program (40 vs. 21%). Conclusion There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease. [ABSTRACT FROM AUTHOR]

Background: No population-based study has evaluated the effects of third trimester ultrasound screening on prognosis. Objective: To study the effects of routine ultrasound screening in the third trimester on perinatal/infant mortality, prevalence of small for gestational age infants (SGA) and low Apgar score. Study Design: Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Deliveries between 1985 and 1996 were included. In all, 16 municipalities including 56 371 pregnancies with routine screening were compared with 59 municipalities and 153 355 pregnancies without third trimester screening. An observational design was applied, using data stored during pregnancy, delivery, and during the first year (infant mortality) at the Swedish Medical Birth Registry, The National Board of Health and Welfare. Odds ratio with 95% confidence interval was used in the evaluation. End-points included incidence of SGA, perinatal/infant mortality, Apgar score at 5 min, cesarean section and instrumental delivery in areas with versus without routine third trimester screening. Results: No significant difference was seen in the prevalence of the most extreme SGA (< -3 SD from the mean), perinatal complications including cesarean section or instrumental delivery, or perinatal/infant mortality between units with versus without routine ultrasound screening in the third trimester. Conclusion: Added to the findings of previous small randomized studies, it seems as if routine third trimester ultrasound screening in an unselected population does not reduce perinatal mortality or early neonatal morbidity, expressed as Apgar scores or SGA. [ABSTRACT FROM AUTHOR]

Background: To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology. Methods: Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study. Results: Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% according to the organ system of the fetus. Conclusions: Our study shows that midtrimester routine ultrasound examination in district hospitals can achieve a detection rate of congenital anomalies comparable with tertiary centers. One-stage ultrasound examination at midtrimester gives acceptable results concerning congenital anomalies with few false-positive results. [ABSTRACT FROM AUTHOR]

Objective. To study the perinatal results in our population, following the prenatal ultra- sound diagnosis of a single umbilical artery (SUA), as this alteration is associated with fetal malformations, chromosomal abnormality, and poor perinatal results. Materials and methods. A retrospective review of all obstetric ultrasounds carried out between October 2000 and December 2003 in our service, obtaining the postnatal results of the fetuses diagnosed with an SUA. Results. From a total of 5987 pregnant patients examined by ultrasound scan at 20th week, an SUA was found in 40 cases, representing an incidence of 0.7%. Of these, 84.6% were normal pregnancies at birth and 15.4% presented other malformations and/or chromosomal abnormalities. No aneuploidy was found in pregnancies where there were no other associated findings in the ultrasound scan at 20 weeks. All cases with serious congenital malformations accompanying the SUA were diagnosed prenatally. There was a 5% of perinatal mortality rate among our fetuses with SUA, which represents a mortality rate 10 times greater than the overall rate among our patients. Conclusions. The ultrasound discovery of an SUA implies the meticulous search for other associated malformations, and in the absence of these, the risk of a chromosomal abnormality is very low, unless it is a high-risk patient. However, the growth and well- being of the fetus must be carefully monitored in the last 3 months, although the ultrasound scan does not show any other associated alterations. [ABSTRACT FROM AUTHOR]

Background: To analyze the clinical and sonographic variables that affect the success of labor induction. Methods: Bishop score, cervical length, and parity were studied in 196 pregnant women in the prediction of successful vaginal delivery within 24 hr of induction. Logistic regression and segmentation analysis were performed. Results: Cervical length [odds ratio (OR) 1.089, P<0.001], Bishop score (OR 0.751, P=0.001), and parity (OR 6.85, P<0.001) predict the success of labor induction. The best cut-off points for cervical length were <16.5, 16.5--27, and >27 mm (P=0.0016). In the analysis of the Bishop score, we also obtained three discriminatory points, 0, 1--4, and >4 (P=0.0006), that best predict the labor induction. Finally, in a global analysis of the variables studied, the best statistic sequence that predicts the labor induction was found when we introduced parity in the first place. The success of labor induction in nulliparous was 50.77 and 83.33% in multiparous (P=0.0001). Conclusions: Cervical length, Bishop score, and parity predict the success of labor induction. [ABSTRACT FROM AUTHOR]

Determination of chorionicity is one of the most important issues in the management of twin pregnancy. Modern ultrasound equipment has made it possible to accurately assess placentation already in the first trimester with the lambda sign. With regard to prenatal diagnosis, it is important to know the chorionicity in order to calculate the risk of chromosomally abnormal fetuses. Accurate chorionicity offers the obstetricians the opportunity to observe the monochorionic twins more intensively than is required for twins with dichorionic placentation. This review gives an update of the state of the art for clinicians caring for twin pregnancies. [ABSTRACT FROM AUTHOR]

Background. To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck. Methods. The severity of the incontinence and mobility the bladder neck were evaluated by pad test and perineal ultrasonography respectively in 74 patients with pure anatomic stress incontinence. During perineal ultrasonography, distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. The first bladder neck mobility was obtained by two caliper method (Mu). After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x-y coordinate system by using computer programs and the corresponding X and Y values were calculated. The second bladder neck mobility was measured on this x-y coordinate system (Mc). Paired t-test and correlation analysis were used for statistical analysis of the data. Results. The mean Mc was significantly higher than the mean Mu (p<0.01). Compared to the values at rest, the mean distance A did not change significantly; however, the mean distance B increased, and X and Y values decreased significantly during stress (p<0.01). The amount of urine leaked per hour had significant positive correlation with distance B-stress and Mc and significant negative correlation with Y-rest, X-stress and Y-stress (p<0.05–0.001). Conclusion. These data suggested that the bladder neck mobility was underestimated when it was measured by two caliper method and the absolute positions or mobility of the bladder neck measured by computer on an x-y coordinate system could effectively document the severity of the decreased support of bladder neck. [ABSTRACT FROM AUTHOR]

Objective. To estimate fetal volume and weight in diabetic and normal pregnancy using high-resolution magnetic resonance imaging. Methods. T1-weighted magnetic resonance imaging was combined with semiautomatic segmentation technique. The accuracy of fetal volume estimations thus obtained was compared with conventional ultrasound-based weight estimations in ten pregnant women with insulin-dependent diabetes mellitus and ten women with normal pregnancy. Examinations were made within 48 hours before delivery. Results. Ultrasound-based estimations of fetal weight showed a correlation rate of r=0.77 with the actual birth weights in the whole material, while volume determinations based on magnetic resonance imaging showed a significantly better correlation rate of r=0.95. Diabetic women did not differ from the normal pregnancy group with regard to birth weight or the accuracy of weight estimations. Conclusions. High-resolution magnetic resonance imaging combined with semiautomatic segmentation software was found to be accurate in determining fetal volume and, consequently, better than conventional ultrasound-based techniques in estimating fetal weight. The use of magnetic resonance imaging in fetal weight estimation may be recommended for clinical situations where an accurate weight estimate is considered essential. [ABSTRACT FROM AUTHOR]

Background. The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared. Methods. One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy. Results. Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001). Conclusions. Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill. [ABSTRACT FROM AUTHOR]

Background. To compare antepartum ultrasonography with magnetic resonance imaging for prenatal diagnosis of malformations in the fetal urinary tract in high risk patients during the last trimester. Materials and methods. The study involved 22 women and 24 fetuses with either severe oligohydramnios or ultrasonographically or clinically suspected abnormality of urinary tract. Ultrasound examination was carried out with 5 MHz abdominal convex probe and magnetic resonance imaging with superconductive 1.5 T equipment. Postnatal findings were used as reference. Results. Correct diagnosis of urinary tract anomaly was done in 15 fetuses on ultrasound and in 20 fetuses on magnetic resonance imaging. Both methods enabled correct diagnosis in 12, only ultrasound in three and only magnetic resonance imaging in eight fetuses. Both methods imaged equivocally in one case. The additional information by magnetic resonance imaging was gained from five fetuses out of 12 pregnancies with oligohydramnios and from three fetuses out of ten pregnancies with normal amount of amniotic fluid. Conclusions. MRI is a valuable additional method to ultrasonography of fetal urinary tract if resolution of ultrasound is impaired for reason of oligohydramnios or technical deterioration. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to describe number, type, time and place for all obstetric ultrasound examinations that pregnant women in Denmark had performed during their pregnancies. Further, to compare these results with results from a similar national survey performed five years previously.Methods: During a two-week period in February 1990 and a two-week period in May 1995, all delivery departments in Denmark (1990: 57/1995: 49) participated in two identical designed studies with the aim as described above. For all women who delivered in these periods variables were recorded from the women's case records and after interview. After the exclusion of 108/145 women without complete registrations, the material consisted of 2268/2315 women; approximately 3.7%/3.4% of all deliveries in Denmark 1990/1995. The chi2 and t-test were used for statistical analyses with a statistical significance level of 5%.Results: Of all obstetric ultrasound examinations 99%/96% took place in hospitals. Twenty/seven percent of the women had no examination during their pregnancies. The mean number of obstetric ultrasound examinations was 1.5/1.9 for all women and 1.9/2.1 for women who had at least one examination. In total 40%/54% of the women were offered a screening examination. Women with an offer of screening had a mean number of examinations: 1.8/2.0 and women without an offer: 1.3/1.9 (1990: p<0.05; 1995: non-significant).Conclusion: The studies have shown an increasing number of women with an offer of ultrasound screening and in general an increased use of ultrasound examinations in obstetrics during the five year period 1990-1995 in Denmark. [ABSTRACT FROM AUTHOR]

Examines the detection rates of second trimester ultrasound screening for neural tubes defects, abdominal wall defects and Down's syndrome (DS) in low risk populations in Scandinavia. Criteria for eligibility to ultrasound screening; Procedure of the screening; Detection rate for DS.

Objective To explore procedures for providing information, assessment and documentation about ultrasound soft markers in Sweden. Design Descriptive, quantitative, cross-sectional survey. Sample Eighty-two percent of all obstetric ultrasound clinics in Sweden (covering >90% of routine fetal ultrasound examinations). Methods Postal questionnaire survey between December 2010 and January 2011. Main outcome measures Items about provision of information, risk estimation, and follow-up strategies in relation to observed ultrasound soft markers. Results More than 96% of all fetal routine ultrasound examinations were performed at 15-21 gestational weeks, primarily by midwives. Half of the clinics replying wanted prospective parents to be provided with information, but 38 (78%) of the clinics did not routinely inform about assessment of soft markers before the examination. Follow up and decisions on whether to give information when soft markers were found were based on the number and type of the observed markers, whether other structural deviations existed, and on the woman's age and anxiety level. Only at eight clinics (17%) were parents informed about all soft marker findings. At 13 clinics (28%) observed markers were documented/recorded, even though the women were not informed. Conclusions Information regarding the assessment and importance of observed soft markers seems to be inconsistent and insufficient. Provision of information and documentation of findings appear to be handled differently at obstetric ultrasound clinics. This suggests that Swedish ethical principles relating to healthcare and ultrasound examinations are incompletely followed and national guidelines appear to be necessary. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the additional information of second trimester magnetic resonance imaging (MRI) compared to ultrasound in fetuses with identified or suspected central nervous system (CNS) anomalies and to study the clinical impact of the information on pregnancy management. Design. Prospective study during 2004-2007. The fetal MRI examination was planned to be performed within 3 days after the ultrasound. Setting. Uppsala University hospital. Material. Twenty-nine pregnant women in whom second trimester ultrasound identified or suspected fetal CNS anomalies. Main outcome measures. Evaluation of the additional information gained from MRI and the consequence it had on pregnancy management. Results. The mean interval between ultrasound and MRI was 1.6 days (range 0-7). In 16 fetuses (55%), MRI verified the ultrasound diagnosis but provided no additional information, while in 10 (35%) MRI gave additional information without changing the management. In 3 (10%), MRI provided additional information that changed the management of the pregnancy. Two of these women were obese. Conclusions. Fetal MRI in the second trimester might be a clinically valuable adjunct to ultrasound for the evaluation of CNS anomalies, especially when ultrasound is inconclusive due to maternal obesity. [ABSTRACT FROM AUTHOR]

Background. To assess the risk of malignant cells dissemination in patients with endometrial cancer undergoing saline infusion sonohysterography (SIS). Methods. Fourteen consecutive patients (mean age: 58.1 years, range: 41–74 years) diagnosed as having a clinical stage I endometrial carcinoma and scheduled for surgical staging were entered in this study. SIS was performed at the time of laparotomy just when the abdomen was opened and prior to the start of the surgical procedure. 10–20 mL of saline was infused. All fluid spilled from the fimbrial ends of the fallopian tubes was collected and analyzed for the presence or absence of malignant endometrial cells. Samplings were also taken from ascites, if found, or cytological washings, prior to and after SIS. Results. SIS could be satisfactorily performed in all patients. There was no spillage from either tube in nine patients. Mean fluid volume obtained from the other five patients was 4.4 mL. Cytologic analysis revealed the presence of malignant cells in the spilled fluid in one case (7.1%, one out of fourteen). Conclusions. Our data show that a small but real risk of malignant cell dissemination exists in patients with endometrial carcinoma who undergo SIS. [ABSTRACT FROM AUTHOR]