Search

Objective: To compare color Doppler ultrasound with real-time ultrasound to determine whether it increased the identification of fetuses with trisomy 21., Methods: Consecutive fetuses with a second trimester risk greater than 1:270 for trisomy 21 were examined with real-time ultrasound (n = 1028) or real-time plus color Doppler ultrasound (n = 1028) before second trimester genetic amniocentesis. The type of abnormal ultrasound findings were compared between fetuses with normal and abnormal chromosomes. Using the Bayes theorem, the ultrasound-adjusted maternal age-related risk (posterior risk) for trisomy 21 was computed after a normal or abnormal real-time plus color Doppler examination., Results: A significantly greater number of fetuses with trisomy 21 (87% [13 of 15] versus 29% [5 of 17], P < .002) were identified with real-time plus color Doppler than with real-time ultrasound. Color Doppler ultrasound identified a significantly higher rate of cardiovascular abnormalities in fetuses with trisomy 21 (60% [9 of 15] versus 12% [2 of 17], P < .008) than did real-time ultrasound. Identification of abnormal fetal anatomy using real-time plus color Doppler in patients 35 years and older increases the likelihood of detecting trisomy 21. A normal real-time plus color Doppler examination of the fetus decreases the risk for trisomy 21 to less than 1:270 until the maternal age of 42, above which the risk for trisomy 21 is greater than 1:270., Conclusion: Real-time plus color Doppler ultrasound examination of the fetus is an alternative for the identification of trisomy 21 for patients who may decline genetic amniocentesis based on their age-related risk.

The Routine Antenatal Diagnostic Imaging With Ultrasound Study (RADIUS) has reported that the adoption of routine screening in the United States would add considerably to health care costs, but stated that a potential benefit may be identification of fetal anomalies. To determine whether the cost per detected malformed fetus using data from the RADIUS study is cost-effective, a comparison is made with the California maternal serum alpha-fetoprotein (MSAFP) screening program. When screening ultrasound is performed by individuals who have a diagnostic rate similar to that reported for tertiary centers that participated in the RADIUS study (6.8 per 1000), the cost for identifying a malformed fetus is $10,805 less ($200 per ultrasound examination) than the cost using MSAFP screening ($40,338; $53 per test). However, when the screening examination is performed by individuals whose diagnostic rate is similar to that reported for non-tertiary centers (1.7 per 1000) that participated in the RADIUS study, the cost for identifying a malformed fetus ($115,575) is $75,237 higher than MSAFP screening. Using data from the RADIUS study, a proposal is suggested by which physicians are reimbursed for second-trimester ultrasound based upon their diagnostic skills. This approach maintains the cost per detected malformed fetus at less than $30,000, decreases the current cost of diagnostic ultrasound to third-party payers, and allows second-trimester ultrasound to be offered as a cost-effective screening test for low-risk patients for identification of malformed fetuses.

The purpose of this study was to describe the ultrasonic measurement of fetal foot length and to develop mathematical models to quantify the relationships between menstrual age and commonly measured fetal structures. We evaluated 120 patients with known last menstrual periods and normal pregnancies to develop a cross-sectional study population. All patients had ultrasonic measurement of the fetal foot length, biparietal diameter, head circumference, abdominal circumference, and femur length. Least-squares estimation of linear models was used to select the best mathematical models to describe the relationship between menstrual age and fetal foot length. A similar evaluation of the relationship between fetal foot length and the other measured parameters was performed. All models were best described by a linear equation. An R2 value of 0.94, with a standard error of the estimate of 0.204, was obtained for menstrual age versus fetal foot length. When the model for fetal foot length and menstrual age was compared with published anatomical data, close agreement was seen over the time interval studied. Our results suggest that the measurement of fetal foot length with ultrasound gives a reliable assessment of anatomical fetal or neonatal foot length and is highly correlated to the menstrual age of the fetus.

As the result of auscultation of fetal bradycardia in a class C diabetic, real-time and M-mode echocardiography were performed at 14 weeks of gestation. M-mode evaluation revealed fetal bradycardia (70 beats per minute) with atrial and ventricular systole occurring simultaneously, suggesting a nodal rhythm. Real-time examination demonstrated a ventricular septal defect, pericardial effusion, ventricular wall hypertrophy, and a dilated aortic root. Also present were fetal ascites and situs inversus of the stomach. A repeat ultrasound examination revealed fetal death at 16 weeks of gestation. Autopsy confirmed the above structural abnormalities, and also demonstrated bilobed lungs, pulmonary artery and valve hypoplasia, midline small intestine, and asplenia.

Over a two-year period, cysts of the fetal choroid plexus were diagnosed prospectively by routine second-trimester ultrasonography in five patients, representing 0.18% of the population scanned for standard obstetric indications. Gestational age at the time of diagnosis ranged from 16-22 weeks. The cysts were located in the posterior portion of the choroid plexus within the lateral ventricle. The maximum diameter ranged from 3-14 mm. In two cases, the cyst was noted to be bilocular. No additional anomalies were detected in any fetus. Follow-up sonography two to five weeks after the initial scan documented disappearance of the cysts in all cases. The course of pregnancy in these patients was otherwise uneventful, and all infants were normal physically and neurologically both at the time of birth and between four and 24 months of follow-up.

Dysfunctional uterine bleeding results from disruption of the normal sequence of ovarian cyclic hormonal stimulation of the uterine endometrium. Treatment of dysfunctional uterine bleeding previously consisted of surgical or hormonal manipulation, or both. The present study was conducted on 34 patients in a randomized double-blind fashion to evaluate the efficacy of treating dysfunctional uterine bleeding with intravenous Premarin. Bleeding stopped in 72% of patients who received intravenous Premarin and in 38% who received placebo (P = .021). Premarin was effective in terminating endometrial bleeding in patients with biopsy-proved pathology consisting of secretory, proliferative, menstrual, polypoid, or cystic hyperplasia, as well as endometritis.

The effect of tocolytics on systolic to diastolic (S/D) ratios used to assess downstream vascular resistance and obtained from umbilical and uterine velocity waveforms has not been studied to date. Continuous-wave Doppler studies were performed on the umbilical and uterine arteries of 60 consecutive patients with the diagnosis of preterm labor. Forty patients receiving intravenous magnesium sulfate and 20 patients receiving intravenous ritodrine tocolysis underwent Doppler studies before therapy, during incremental therapy, and four hours post-therapy. There was a statistically significant (P less than .001) progressive decrease in the uterine and umbilical S/D ratios along with a concomitant increase in maternal and fetal heart rate associated with increasing infusion doses of ritodrine. Both the S/D ratios and heart rates returned to pretherapy range four hours after discontinuing therapy. Magnesium sulfate tocolysis was not associated with any significant change in S/D ratios or maternal and fetal heart rate. We conclude that intravenous ritodrine affects umbilical and uterine vascular resistance as measured by S/D ratios. This response may be secondary to changes in maternal and fetal heart rate.

Systolic to diastolic (S/D) ratios of umbilical velocimetry using either continuous-wave or pulsed-wave Doppler ultrasound have been used to assess downstream placental resistance. The purpose of this study was to compare the S/D ratios obtained by both types of instrumentation to determine whether there are significant differences between measurement values. Umbilical velocimetry was performed on 200 high-risk pregnancies in the third trimester using the Angioscan III to obtain continuous-wave velocimetry and the General Electric RT3600 to obtain pulsed-wave velocimetry. Systolic to diastolic ratios were considered abnormally high if they were greater than 3. One hundred sixty-five patients had normal S/D ratios and 35 patients had elevated ratios on both continuous-wave and pulsed-wave ultrasound. There was no significant difference in the mean S/D ratios obtained by either method for the entire population (continuous-wave S/D 2.81 +/- 1.79, pulsed-wave S/D 2.71 +/- 1.83, R = 0.98), the normal group (continuous-wave S/D 1.96 +/- 0.41, pulsed-wave S/D 1.95 +/- 0.40, R = 0.91), and the abnormal group (continuous-wave S/D 6.23 +/- 1.58, pulsed-wave S/D 6.35 +/- 1.52, R = 0.94). Least-square regression was performed to model the relationships between pulsed wave and continuous wave, with both used as dependent variables. The slopes and intercept for the normal and abnormal groups were evaluated and were significantly different (P less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Sixty-three patients with antenatally diagnosed fetal malformations over the period of 14 months were prospectively offered genetic amniocentesis, irrespective of gestational age. An additional 15 patients were excluded from the study because of a known lethal malformation (13 anencephaly, two amniotic bands). Twenty patients accepted amniocentesis, and seven chromosomal disorders were found. Obstetric management was altered in some of these patients as a result of the anomalies.