摘要:

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.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A prospective ultrasound study was conducted in 179 normal pregnant women with gestational ages ranging from 15–40 weeks. Several biometric measurements were obtained throughout pregnancy, including the cerebrofrontal horn distance of the lateral ventricle, the frontal hemispheric width, and the calculated ratio of cerebrofrontal horn distance/hemispheric width. Curvilinear relationships were found between cerebrofrontal horn distance and gestational age (R2=0.597;P< .0001) and between cerebrofrontal horn distance and the biparietal diameter (R2=0.618;P<.0001). In addition, a curvilinear relationship existed between cerebrofrontal horn distance/hemispheric width ratio and gestational age (R2=0.492;P<.0001) and biparietal diameter (R2=0.930;P<.0001). These data represent a comprehensive characterization of normal growth of the fetal frontal horns. They provide a method by which variations from the norm can be assessed and early prenatal diagnosis of developmental anomalies of the fetal ventricular system can be made.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fibronectin, a large-molecular-weight glycoprotein present on cell surfaces and in human plasma, promotes cell adhesion and may modulate reticuloendothelial clearance of particulate debris and bacteria. Amniotic fluid is known to contain a heavily glycosylated variety of fibronectin, and cells derived from amniotic fluid synthesize and secrete fibronectin in tissue culture. The purpose of this study was to determine the relationship between the concentration of fibronectin in amniotic fluid and gestational age. Amniotic fluid samples, obtained from 54 women whose pregnancies ranged in gestation from 15–40 weeks, demonstrated a significant decrease in fibronectin levels with increasing duration of pregnancy (r=–0.70). Diminished concentrations of amniotic fluid fibronectin in the latter stages of pregnancy may represent either decreasing synthesis by amniocytes or a dilutional effect from fetal urine.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Clinically asymptomatic women with laboratory abnormalities in autoantibody profiles have recently been shown to experience reproductive failure. The evaluation of autoantibody panels and the establishment of normal cutoff values in clinically apparently healthy populations has therefore achieved increasing importance. Investigation of 400 clinically asymptomatic patients (200 females and 200 males) for the presence of autoantibodies to six phospholipids, five histone subtractions, and four polynucleotides revealed a nonparametric distribution of autoantibodies primarily for antiphospholipids and antihistone antibodies. This observation suggests that widely used parametric methods for the determination of normal autoantibody levels are inadequate and will give an unreasonably high incidence of abnormal results. Consequently, rather than the widely used 95% confidence interval, we used the 99% confidence interval (based on medians) to determine the upper limit of normal for various autoantibodies. This resulted in the detection of four to 13 positive patients (out of 400) per antigen, for a positivity rate of 1–3%.A more rigid definition of normal and abnormal autoantibody levels is essential to pursue accurately diagnostic and therapeutic considerations concerning the newly evolving concept of subclinically abnormal autoimmunity.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Continuous-wave and pulsed Doppler ultrasound measurements of blood flow velocity waveforms of both uterine and umbilical arteries were performed on 85 patients to assess the correlation between these two measurement techniques. Peak systolic to end-diastolic (S/D) ratios measured by continuous-wave devices were not statistically different (P> .05) from those measured by a pulsed Doppler device. The S/D ratios of the umbilical artery measured by each device showed a strong correlation, whether measured by one observer (r=0.93) or two observers (r=0.89). Uterine artery ratios showed a weaker, although still significant, correlation (r=0.57). Pulsed Doppler is not routinely necessary for the identification and measurement of umbilical and uterine artery S/D ratios.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

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 HI 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<.01). The parameter estimates, correlation coefficient, and standard error of the estimate for each model of the entire population were as follows: continuous wave=0.08 + 0.97 pulsed wave, 0.98, and 0.28; and pulsed wave=-0.01 + 1.01 continuous wave, 0.98, and 0.28, respectively. For the normal group, the values were: continuous wave=0.14 + 0.94 pulsed wave, 0.84, and 0.17; and pulsed wave=0.20 + 0.89 continuous wave, 0.84, and 0.17, respectively. For the abnormal group, continuous wave=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 HI 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< .01). The parameter estimates, correlation coefficient, and standard error of the estimate for each model of the entire population were as follows: continuous wave=0.08 + 0.97 pulsed wave, 0.98, and 0.28; and pulsed wave=−0.01 + 1.01 continuous wave, 0.98, and 0.28, respectively. For the normal group, the values were: continuous ve= 0.14 + 0.94 pulsed wave, 0.84, and 0.17; and pulsed wave=0.20 + 0.89 continuous wave, 0.84, and 0.17, respectively. For the abnormal group, continuous wave = 0.10 + 0.97 pulsed wave, 0.87, and 0.57; and pulsed wave=0.71 + 0.90 continuous wave, 0.87, and 0.55, respectively. We conclude that there is no significant difference in the mean umbilical artery S/D ratios obtained by either pulsedwave or continuous-wave ultrasound, although there is a quantifiable relationship between S/D ratios obtained by these two methods, with the slopes of the normal and abnormal groups significantly different.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study was undertaken to evaluate the role of umbilical artery flow velocimetry combined with sonographic estimation of fetal weight, head circumference to abdominal circumference ratio, femur length to abdominal circumference ratio, and qualitative determination of amniotic fluid volume as a comprehensive test for the detection of intrauterine growth retardation (IUGR). The following cutoff values were used to indicate abnormal test results: 1) umbilical artery peak systolic to end-diastolic ratio (S/D) above 3, 2) estimated fetal weight below the tenth percentile for gestational age, 3) head circumference to abdominal circumference ratio more than 2 SD above the mean for gestational age, 4) femur length to abdominal circumference ratio above 23.5%, and 5) qualitative amniotic fluid volume less than 2 cm. The study population consisted of 127 patients referred with a clinical suspicion of IUGR. Forty-five infants (35%) were small for gestational age. None of these five tests were uniformly successful in identifying growth-retarded infants. Overall, the best predictor appeared to be estimated fetal weight below the tenth percentile for gestational age, which correctly identified 39 of the 45 IUGR infants (sensitivity 87%, specificity 87%). The sensitivity of this test was nearly twice that of any other test. AH indices performed similarly in predicting the non-IUGR infant (range of specificities 87–98%).

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Obstetric and neonatal performance were analyzed in an ultrasound-dated small for gestational age (SGA) population from 1982–1985. Eighty-three percent of 160 SGA infants were identified antenatally by means of intrauterine growth retardation (IUGR) risk scoring, and the pregnancies were supervised at a high-risk clinic. Fifty percent were delivered electively, predominantly in gestational weeks 38–39. Thirty percent were born preterm. The cesarean section rate was 40%. Perinatal mortality was 6%, or 4% when lethal malformations were excluded, ten times higher than the corresponding total population figures. Eleven percent of the fetuses had severe malformations. In the remaining SGA population, one infant died after experiencing severe perinatal asphyxia and another developed cerebral palsy; no other major sequelae were found before the age of 18 months. Hypoglycemia and hypothermia occurred frequently, but these problems were managed satisfactorily. The mean hospital stay for term infants was twice that of appropriate for gestational age infants. We conclude that the extra attention paid to the SGA population is well motivated. Future efforts should be directed toward improving the diagnostic techniques for IUGR, as most of the perinatal mortality occurred among SGA infants not identified before birth.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The relationship between intrapartum fetal acid-base status and fetal heart rate (FHR) response to vibro-acoustic stimulation was investigated in 100 patients. Fetal heart rate responses were classified into three groups: acceleration of 15 or more beats per minute lasting 15 or more seconds, acceleration of ten or more beats per minute lasting 10 seconds but less than 15 beats per minute and 15 seconds, or no acceleration. The mean fetal scalp blood pH was 7.29 in both groups with acceleratory responses, and such responses were highly predictive (98–100%) of scalp pH 7.20 or above. The mean pH value for the no-acceleration group (7.22) was significantly lower than the mean pH value for both groups with an acceleratory response (P< .05), and the lack of response to the stimulus detected 90–100% of fetuses with a pH below 7.20. This sensitivity was reduced to 45% in the detection of fetuses with pH less than 7.25.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Elevated levels of maternal serum alpha-fetoprotein (MSAFP) will identify a population at increased risk for specific congenital malformations, which are accurately diagnosed by amniotic fluid AFP and acetylcholinesterase. The risk for spontaneous abortion related to amniocentesis, combined with increasing confidence in the accuracy of ultrasound diagnosis, has caused us to question the need for amniocentesis in the diagnostic workup of pregnancies complicated by elevated levels of AFP in maternal serum. A retrospective study of 257 pregnancies evaluated for elevated serum AFP levels revealed 16 fetal malformations diagnosed by amniotic fluid AFP and acetylcholinesterase. Only 12 of these malformations were diagnosed on the initial ultrasound study. All malformations were diagnosed when ultrasound examination was repeated for increased acetylcholinesterase activity. Earlier gestational age at scanning, smaller defects, and pure technical failure were implicated as causes of misdiagnosis. The rate of fetal malformations identified in this high-risk population (6.23%) and the rate of ultrasound misdiagnosis (1.5% of the population with elevated levels of MSAFP) imply that amniocentesis should still be considered an essential part of the diagnostic workup in these situations.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID