Search

A finding of a short cervical length (CL) during the second trimester on transvaginal ultrasound predicts preterm birth. Previous data from a meta-analysis and a large trial have shown that cerclage prevents preterm birth in singleton women with a previous preterm birth, once a short cervix has been detected on ultrasound imaging. Because the CL at which cerclage was performed varied between ≤15 mm and

Objectives To determine the incidence of cardiac disease associated with abdominal wall defects of fetuses and associated parameters including maternal age, sex, gestational age at delivery, outcome, karyotypes, Apgar scores and associated congenital anomalies. Methods This was a retrospective study of fetuses with a prenatal diagnosis of gastroschisis or omphalocele. The Maternal–Fetal Medicine Fetal Therapy (MFM) database was reviewed for all fetuses with abdominal wall defects identified prenatally. All available MFM records, fetal echocardiograms, neonatal echocardiograms and neonatal charts were reviewed for the types of abdominal wall defects and associated cardiac disease identified by ultrasound. Other parameters reviewed included: maternal age, sex, gestational age at delivery, outcome, karyotypes (when available), Apgar scores and associated congenital abnormalities. Results Forty-eight fetuses with an abdominal wall defect and cardiac disease findings were identified. Of these fetuses 26 had gastroschisis and 22 had omphalocele. The mean maternal age was 24.0 ± 5.40 years in the gastroschisis and 29.2 ± 7.23 years in the omphalocele group (P < 0.01). Differences in mean gestational age at delivery, mean birth weight and median Apgar scores at 1 and 5 min were not statistically significant. Abnormal cardiac findings were seen in 4/26 (15%) cases of gastroschisis and included one case of peripheral pulmonary stenosis, two cases of supraventricular tachycardia and one case of persistent pulmonary hypertension (PPHN) of the newborn. Abnormal cardiac findings were seen in 10/22 (45%) cases of omphalocele and included one muscular ventricular septal defect, two atrial septal defects of the secundum variety, one ectopia cordis, one coarctation of the aorta, one dysplasia of the tricuspid valve, one large pericardial effusion and four cases of PPHN. Conclusions Fetuses with omphalocele appear to have an increased risk not only of congenital heart disease (CHD) but also of perinatal cardiac abnormalities, especially PPHN. A prenatal maternal hyperoxia test may be of predictive value in determining which patients may develop PPHN. The fact that both CHD and PPHN are increased in fetuses with abdominal wall defects may be of value in counseling parents prenatally, and stresses the importance of performing echocardiography both prenatally and postnatally in these cases. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. Methods Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. Results One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4–5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 ± 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 ± 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 ± 2.9 weeks. Conclusion A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To determine the transvaginal ultrasound features and risk factors that predict preterm delivery (PTD) preceded by either preterm premature rupture of membranes (PPROM) or preterm labor (PTL) in a high-risk population. Study design Singleton gestations at high-risk for preterm delivery were screened prospectively with transvaginal ultrasound between 14 and 24 weeks. Univariate and multivariate regression analyses were performed for historical obstetric risk factors and transvaginal ultrasound features (cervical length (CL) and cervical funneling (CF)) for the prediction of PTD preceded by PPROM or PTL at < 32 and < 35 weeks' gestation, respectively. Indicated preterm deliveries were excluded. Results Of 321 patients screened, 71 (22%) delivered at 25% (P 25% (P < 0.0001). The significant predictors of PPROM at < 32 weeks were cerclage in the current pregnancy (P < 0.006) and CL < 25 mm (P < 0.0001); for PTL at < 32 weeks they were a past history of spontaneous miscarriage between 14 and 24 weeks (P < 0.02), black race (P < 0.021), cerclage in the current pregnancy (P < 0.001) and CL < 25 mm (P < 0.001). Multivariate regression analysis revealed the significant predictors of PPROM at < 35 weeks to be: a history of PTD between 25 and 30 weeks with odds ratio (OR) 4.8 (95% confidence interval (CI), 1.9–11.5) and CL < 25 mm with OR 7.9 (95% CI, 3.6–17.5). The significant predictors of PTL at < 35 weeks on multivariate regression were black race with OR 2.2 (95% CI, 1.0–4.8) and unemployment with OR 1.2 (95% CI, 1.0–1.5). For deliveries < 32 weeks, CL < 25 mm (OR, 10.1; 95% CI, 3.2–32) was the only significant predictor of PPROM. Significant predictors of PTL were unemployment (OR, 1.3; 95% CI, 1.1–1.7), a history of spontaneous miscarriage between 14 and 24 weeks (OR, 6.2; 95% CI, 1.4–25), black race (OR, 8.6; 95% CI, 1.5–47) and CL < 25 mm (OR, 4.4; 95% CI, 1–19). The sensitivity, specificity and positive and negative predictive values of CL < 25 mm for PPROM at < 35 weeks were 73%, 69%, 25% and 95%, respectively; for PTL at < 35 weeks they were 58%, 66%, 15% and 94%; for PPROM at < 32 weeks they were 85%, 68%, 20%, and 98%; for PTL at < 32 weeks they were 70%, 66%, 12% and 97%. Conclusion There are differences in both transvaginal ultrasound findings and risk factors that predict PPROM or PTL. Of the pathways leading to PTD, CL was a more significant predictor of PPROM compared with PTL, while sociodemographic factors were more predictive of PTL. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To determine in patients with a cervical length < 25 mm on transvaginal ultrasound if the severity of cervical length shortening can be used to predict preterm premature rupture of membranes (PPROM) and the contribution of PPROM to preterm delivery in these patients. Methods We retrospectively reviewed asymptomatic singleton pregnancies between 14 and 24 weeks at high risk of preterm delivery by obstetric history and transvaginal cervical length < 25 mm. Cases developing subsequent PPROM were compared with controls for transvaginal sonographic cervical characteristics. Results Of 69 patients identified to have a cervical length 75% (sensitivity, specificity, positive and negative predictive values of 33, 93, 75 and 68%, respectively; odds ratio, 6.5; 95% confidence interval, 1.6–26.9). Stepwise logistic regression revealed cervical length to be a significant predictor of PPROM (odds ratio, 4.0; 95% confidence interval, 1.1–14.2). Conclusion In patients at high risk for preterm delivery because of obstetric history and transvaginal sonographic cervical length 75% were most predictive of PPROM. PPROM was the major contributor to preterm delivery in these patients. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To develop a standard technique for using three-dimensional ultrasound (3D US) to study and evaluate the cervix in pregnant women at high risk for premature delivery, comparing the findings on 3D US with those on conventional two-dimensional ultrasound (2D US). Study Design Twenty-one pregnant women at high risk for premature delivery had a total of 37 transvaginal 2D and 3D US examinations of the cervix between 11 and 32 weeks' gestation. A 3D US vaginal probe (5.0–8.0 MHz, Voluson 530D, Medison, Pleasanton, CA, USA) was used. Measurements made from the 2D and 3D US were compared. Results Of the 37 cervical length measurements in 3D US sagittal plane, seven were shorter and three were longer than on 2D US (varying by 5–15 mm) indicating that the true mid-sagittal plane was not obtained in ten (27%) of the 37 2D US examinations. Of 21 examinations showing funneling, funneling was seen on both 2D and 3D US in 15, but was seen only on 3D US in six. There was a significant (P < 0.05) difference between funnel width as measured in the coronal 3D plane versus 2D US, as well as between funnel width in the coronal 3D US plane versus sagittal 3D US plane (P < 0.05). The cerclage was seen in its entirety in nine of 10 examinations; the 3D US axial plane was most valuable for imaging the cerclage. Conclusions 3D US appears to offer a more complete assessment of the cervix than 2D US. Multiplanar correlation shows that the standard 2D US sagittal view may under- or over-estimate cervical length. Our preliminary data suggest that 3D US has the potential to improve our understanding of cervical morphology. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Objectives To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation. Methods Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation. Results Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length ≤ 25 mm and ≤ 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0–10.3 and R.R. 3.6, C.I. 1.6–7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02–0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix ≤ 30 mm and any funneling were strongly predictive of PTD. Conclusions Both cervical length ≤ 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

Our objective was to establish sonographic criteria that are predictive of preterm delivery in patients with internal os dilatation (funneling). The study population consisted of patients with cervical funneling identified on translabial or transvaginal ultrasound examination. Funnel length, functional length, percentage funneling and funnel width were evaluated for their predictive values for preterm delivery. In the 43 patients who met the study criteria, funneling was detected at a mean gestational age of 21.4 weeks (range 16-28). Twenty-three of 31 patients (74%), manually examined immediately following the ultrasound examination, had a closed cervix. Preterm delivery occurred in 42% of patients. Funnel length of > or = 16 mm, functional length of or = 40% and funnel width of > or = 14 mm correlated significantly with preterm delivery. Patients with funneling of 50% had preterm delivery rates of 17%, 29% and 79%, respectively.

Objectives: To compare the effects of maternal hyperoxygenation on the Doppler waveforms in twin pregnancies where one fetus has IUGR and absent or reversed end diastolic flow (ARED) in room air. Methods: Women with monochorionic diamniotic twin pregnancies with one IUGR fetus with ARED in room air between 2006 and 2008 who were hospitalized after 24 weeks gestation for close surveillance and bed rest were included in the study. All fetuses had structurally normal hearts. None had evidence of twin-twin transfusion syndrome. Measurements of Doppler flow pattern in middle cerebral artery (MCA), free loop of umbilical artery (FLUA) and ductus venosus (DV) were made in room air and then after breathing 60% oxygen by face mask for twenty minutes. Results: Seven twin pregnancies were included. The normal cotwin in each case had normal Doppler waveforms in room air and oxygen. All seven IUGR fetuses had ARED in room air and dilated DV size. In five patients, the FLUA normalized (PI < 1.75) after breathing 60% oxygen (mean PI = 3.21 in room air versus mean PI = 1.65 in oxygen). These five patients who had positive change with oxygen delivered an average of 5 weeks (range 3–14 weeks) after hospitalization. The other two patients who had no change in FLUA with oxygen and had abnormal MCA and DV in room air were delivered for obstetric indications within one day of the test. Conclusions: Maternal hyperoxygenation may be associated with normalization of the FLUA in fetuses with ARED after 24 weeks of gestation. A positive maternal hyperoxygenation test can select IUGR fetuses who have an abnormal FLUA in room air with a better prognosis and may be useful in postponing delivery in these fetuses with ARED.

37.4 ± 3.5 vs 38.4 ± 1.8 (P = 0.006); rate of preterm birth < 34 wks: 11 cases vs 4 cases (P < 0.001); SGA: 32 cases vs 17 cases (P < 0.001). At the logistic regression the abnormal UtA was the only variable significantly releated with adverse outcome. An abnormal UtA Doppler is significantly related to PE, preterm birth below 34 weeks and rate of newborns SGA. At the logistic regression the abnormal UtA Doppler remained the only variable statistically releated with severe pregnancy complications. The PPV of the method is 61% with a sensitivity of 57% and a specificity of 82%. Conclusions: Unless these results are unsatisfactory for a screening test this method permain an useful predicting test if compared with the only previous clinical history (10%); in fact patients with an abnormal test have a risk to develop severe complications of pregnancy 6 times higher than patients with a normal Doppler.

Objectives: To compare the effects of maternal hyperoxygenation on the Doppler waveforms in twin pregnancies where one fetus has IUGR and absent or reversed end diastolic flow (ARED) in room air. Methods: Women with monochorionic diamniotic twin pregnancies with one IUGR fetus with ARED in room air between 2006 and 2008 who were hospitalized after 24 weeks gestation for close surveillance and bed rest were included in the study. All fetuses had structurally normal hearts. None had evidence of twin-twin transfusion syndrome. Measurements of Doppler flow pattern in middle cerebral artery (MCA), free loop of umbilical artery (FLUA) and ductus venosus (DV) were made in room air and then after breathing 60% oxygen by face mask for twenty minutes. Results: Seven twin pregnancies were included. The normal cotwin in each case had normal Doppler waveforms in room air and oxygen. All seven IUGR fetuses had ARED in room air and dilated DV size. In five patients, the FLUA normalized (PI < 1.75) after breathing 60% oxygen (mean PI = 3.21 in room air versus mean PI = 1.65 in oxygen). These five patients who had positive change with oxygen delivered an average of 5 weeks (range 3–14 weeks) after hospitalization. The other two patients who had no change in FLUA with oxygen and had abnormal MCA and DV in room air were delivered for obstetric indications within one day of the test. Conclusions: Maternal hyperoxygenation may be associated with normalization of the FLUA in fetuses with ARED after 24 weeks of gestation. A positive maternal hyperoxygenation test can select IUGR fetuses who have an abnormal FLUA in room air with a better prognosis and may be useful in postponing delivery in these fetuses with ARED.

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.

We sought to define growth parameters of normal fetal heart structures throughout gestation from our database of 2246 normal comprehensive fetal echocardiograms (FECHO). Methods In a retrospective cross sectional study, we evaluated the FECHO results of 2246 normal fetuses. Fetuses had been studied for reasons of family history of congenital heart disease or possible exposure to teratogenic medications, advanced maternal age without karyotyping, suspected abnormalities or difficulty in obtaining complete heart views. None of this group had structural or functional heart disease or arrhythmias. All measurements were performed on a Voluson 730 by one sonographer between 2006 and 2008. Standard cardiovascular diameter measurements were performed on frozen magnified, high resolution images. Valves were measured in long axis at the annulus during diastole with 2 leafets in the image. Systolic and diastolic ventricular measurements were made by follow-the-line methods. These included: ductus venosus size (DV), aorta annulus size (AoV), pulmonary valve annulus size (PV), tricuspid annulus size (TV), mitral annulus size (MV), superior vena cava (SVC) and inferior vena cava (IVC) at the diaphragm sizes, as well as the M-mode measurements including interventricular septum at diastole (IVSD), left ventricular posterior wall dimension at diastole (LVPWD), interventricular septum at systole (IVSS), left ventricular posterior wall dimension at systole (LVPWS) across gestation. Results

Objective: To present an investigation of range of the pulsatility index (PI) and the smallest diameter in the ductus venosus (DV) in normal fetuses with normal DV Doppler flow patterns (PI) throughout gestation. Methods: This was a cohort study performed by one sonographer between September 2004 and March 2006. The DV was identified by color aliasing of the vessel arising from the intraabdominal umbilical vein; the color scale then increased and the color gain reduced until the echogenic surfaces of the DV could be observed with near transparent color flow. At least 3 measurements were made in each fetus, all performed during fetal quiescence. SPSS software was used to create nomograms for DV size and PI against gestational age (GA) from 1000 cases of normal fetuses with normal outcomes. 1,175 normal fetuses age 12 to 40 weeks with average growth, were evaluated for Doppler flow in the DV after obtaining IRB approval. Results: 1039 cases (88.43%) of DV PI measurement and 1000 cases (85.11%) of DV size measurement were recorded as satisfactory measurements. A nomogram was constructed from the results, using the average of the three measurements for each fetus. The median size of the DV was linear across gestation. The DV PI was highest in first trimester. All of the fetuses were discharged after term delivery in normal condition.

Objective: To present an investigation of range of the pulsatility index (PI) and the smallest diameter in the ductus venosus (DV) in normal fetuses with normal DV Doppler flow patterns (PI) throughout gestation. Methods: This was a cohort study performed by one sonographer between September 2004 and March 2006. The DV was identified by color aliasing of the vessel arising from the intraabdominal umbilical vein; the color scale then increased and the color gain reduced until the echogenic surfaces of the DV could be observed with near transparent color flow. At least 3 measurements were made in each fetus, all performed during fetal quiescence. SPSS software was used to create nomograms for DV size and PI against gestational age (GA) from 1000 cases of normal fetuses with normal outcomes. 1,175 normal fetuses age 12 to 40 weeks with average growth, were evaluated for Doppler flow in the DV after obtaining IRB approval. Results: 1039 cases (88.43%) of DV PI measurement and 1000 cases (85.11%) of DV size measurement were recorded as satisfactory measurements. A nomogram was constructed from the results, using the average of the three measurements for each fetus. The median size of the DV was linear across gestation. The DV PI was highest in first trimester. All of the fetuses were discharged after term delivery in normal condition.

Introduction Patients with mullerian anomalies have higher rates of preterm delivery (PTD), but the true reason for PTD has not been elucidated. Transvaginal ultrasound (TVU) has proven an accurate test for the prediction of PTD, but has not been studied in this patient population. Methods Patients with known mullerian anomalies were followed prospectively in pregnancy with TVU of the cervix between 14 and 24 weeks. The predictive value of TVU was evaluated using 25% funneling as definition for a short cervix. The primary outcome was PTD