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Measurements of obstetrics conjugate, the shortest anteroposterior diameter of the pelvic inlet, and pelvic aperture angle by ultrasonographic tomography
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l”‘, 2”d, 3’d and 6’h month of treatment. At the same time-intervals endometrial thickness was measured using transvaginal ultrasonography. Results: In the PMW of the Groups 1, 2 and 3 the values of carotid and uterine PIs were significantly (PcO.05) and similarly decreased during the treatment, whereas in women of group 4 they did not change. Only in Group 3 endometrial thickness was significantly higher during the treatment period than before (P
P4.18.07 INTRACARDIAC ECHOGENIC FOCUS : NO APPARENT ASSOCIATION WITH STRUCTURAL CARDIAC ABNORMALITY I. Wolman’ S. Diamantz, R.I. Gull’, .I. Hartoov’, R. Amster’, -> JB. Lessi&, AJ Jaffa’ Ultrasound Unit’ and Department of Obstetrics and Gynecology3 Lis Maternity Hospital, and the Echocardiographic laboratory, Dana Hospital for Childrer?, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel Objective: The purpose of this prospective study was to evaluate whether intracardiac echogenic foci (ICEF) are related to impairment of ventricular performance. Study Methods: 3744 low risk patients were prospectively evaluated by the same ultrasonographer. A 4-chamber view of the heart and the cardiac outlet of the great vessels were demonstrated in all fetuses. ICEF were defined as an hyperechogenicity located on the chordae tendinae. Fetuses with ICEF underwent further full echocardiographic evaluation. These fetuses were compared to a control group of 167 fetuses without any apparent cardiac pathology who underwent a full echocardiographic evaluation due to the mother request. Neonates were clinically examined, and referred for an additional echocardiographic evaluation only if a clinical suspicion of cardiac impairment arose. Results: Of the 3744 patients in the study group, 138 fetuses (3.7%) presented with ICEF. The majority of the ICEF (78%) were located in the left ventricle, 18% were located in the right ventricle and 4% were bilateral. Of the 138 fetuses in this group, there was one case (0.7%) of pulmonic stenosis in a twin gestation. The co-twin did not demonstrate any ICEF. There was no other cardiac malformation or dysfunction in the other fetuses. Of the 167 fetuses in the control group, there was one case of fetal bicuspid aortic valve. There was no statistical significance between the 2 groups. Conclusions: We conclude that the finding of ICEF is not correlated with cardiac dysfunction. However, these lesions should be carefully differentiated from rhabdomyoma or teratoma
P4.18.08 MEASUREMENTS OF OBSTETRICS CONJUGATE, THE SHORTEST ANTEROPOSTERIOR DIAMETER OF THE PELVIC INLET, AND PELVIC APERTURE ANGLE BY ULTRASONOGRAPHIC TOMOGRAPHY Mitsuhiro Yoshinaza’, M. Katanozaka’, K. Fuchiwaki ‘, Y. Nagata’. Kagoshima University Hospital, 8-35-l Sakuragaoka, Kagoshima, Japan; 2Fuchiwaki Ladies Clinic, Miyakonojou City, Japan. Objectives: To determine the usefulness of the measurements of ultrasonographic obstetrics conjugate (UOC), the shortest anteroposterior diameter of the pelvic inlet(UAPD), and pelvic aperture angle(UPA) for the assessment of dystocia. Study Methods: Subjects were 165 primigravida women, who had delivered at the Dept of OBIGYN, Kagoshima University Hospital, between January 1997 and August 1999. At 36 to 40 weeks of gestational age, fetal biparietal diameter (BPD), maternal UOC, UAPD, and UPA were measured by transabdominal ultrasonographic tomography. Relationship between these variables and dystocia was investigated retrospectively. Results: Mean value of UAPD was 13.1 m} 0.9 (range, ll.lm\15.1 cm). Mean difference in UAPD and BPD (UAPDm\BPD) was 3.8 m} 0.8 (range, 1.8m\5.9 cm). Of 21 women with UAPDm\BPD (_ 3.0 cm), 13 women (61.9%) underwent cesarean deliveries because of cephalopelvic disproportion (CPD). Mean value of UPA was 88.3 m} 8.8m (range, 65
THURSDAY,
SEPTEMBER
to 115m ). Of 24 women with UPA (_80m ), 9 women (37.5%) underwent cesarean deliveries because of CPD. One hundred twentythree women with both UAPDm\BPD (> 3.0 cm) and UPA (> 80m ), only two women (1.6%) underwent cesarean deliveries. Cesarean rate in these women was significantly lower than that in women with UAPDm\BPD (_ 3.0 cm) or UPA (_ 80m ) (P < 0.001). Conclusions: Based on these results, we conclude that ultrasonographic measurements of UOC, UAPD, and UPA are useful to predict the dystocia.
P4.18.09 OBSTRUCTIVE UROPATHlES A. Patil, H. Divakar, P. Chitra, Divakars Hospital, BTM Layout, Bannerghatta Road, Bangalore, Karnataka, India, 560076. Objectives: To determine the incidence of urinary tract abnormalities detected in the presence of mild to moderate fetal renal pelvis dilatation. Study Materials: 1200 routine prenatal mid trimester ultrasound examinations were performed over 2 years (January 1998 to December 1999). Results: 48 (4%) cases showed mild renal pelvis dilatation (greater than or equal to 4 mm). Of these 29 cases showed regressive patterns, 11 cases showed a stable pattern and 8 cases showed an evolutive pattern on follow up scans. In the presence of an evolutive pattern 6 cases showed presence of urinary tract obstruction (2 cases of unilateral PUJ obstruction, 1 case of bilateral PUJ obstruction, 2 cases of posterior urethral valve, 1 case of multicystic kidney). Obstetric management decisions were mainly based on routine fetal surveillance and AFI measurements, the liquor volume being used as indirect evidence of fetal renal function. Neonatal follow up and definitive management of cases will be presented. Conclusion: Measurements of the anteroposterior diameter of the fetal renal pelvis and assessment of the degree of caliectasis does provide important Clinical information that permits early and effective postnatal management.
P4.18.10 PREDICTING RISK OF PRE-ECLAMPSIA BY QUANTITATIVE ASSESSMENT OF DIASTOLIC NOTCH IN UTERINE ARTERY FLOW VELOCITY WAVEFORM A. Ohkuchi (l), H. Minakami (l), H. Mori (2), T. Nakano (2), M. Tateno (3), I. Sato (1) (1) Dept. OBIGYN, Jichi Medical School, Tochigi, Japan. (2) Dept. OBIGYN, Toyama Prefectural Central Hospital, Toyama, Japan. (3) Dept. OBIGYN, Toyama Red Cross Hospital, Toyama, Japan. Objectives: We have developed a new quantitative index, the notch depth index (NDI). We evaluated the association of the ND1 with the risk of pre-eclampsia, and compared its clinical utility with that of other indices, the uterine artery resistance index (RI) and the AC ratio. Study Methods: Uterine artery color Doppler ultrasound was performed in 288 consecutive healthy pregnant women at 20.2e2.0 (range, 16.0 to 23.9) weeks of gestation. The ND1 represents the depth of the early diastolic notch divided by the maximal diastolic velocity. Results: Nine (3.1%) of the 288 women developed pre-eclampsia. The ND1 was associated with subsequent onset of pre-eclampsia. The optimal cutoff value for the ND1 in predicting pre-eclampsia was 0.14, which gave a sensitivity, specificity, and a positive predictive value (PPV) of 67%, 93%, and 22%, respectively. The PPV of the NDI, 22%, was the largest of the three indices evaluated (12% for he RI and 16% for the AC ratio). The relative risk for pre-eclampsia in women with 2 the optimal cutoff value of the RI, AC ratio and the ND1 was 9.7 [95% CI, 2.5-3.71, 19.2 [4.2-911, and 19.2 [5.1-711, respectively. The ND1 of 0.14 improved the PPV of 18% determined by the presence of notches in bilateral uterine arteries. Conclusions: The ND1 value in the second trimester was associated with the onset of pre-eclampsia, and was more useful clinically in predicting pre-eclampsia than were two conventional indices.
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l”‘, 2”d, 3’d and 6’h month of treatment. At the same time-intervals endometrial thickness was measured using transvaginal ultrasonography. Results: In the PMW of the Groups 1, 2 and 3 the values of carotid and uterine PIs were significantly (PcO.05) and similarly decreased during the treatment, whereas in women of group 4 they did not change. Only in Group 3 endometrial thickness was significantly higher during the treatment period than before (P
P4.18.07 INTRACARDIAC ECHOGENIC FOCUS : NO APPARENT ASSOCIATION WITH STRUCTURAL CARDIAC ABNORMALITY I. Wolman’ S. Diamantz, R.I. Gull’, .I. Hartoov’, R. Amster’, -> JB. Lessi&, AJ Jaffa’ Ultrasound Unit’ and Department of Obstetrics and Gynecology3 Lis Maternity Hospital, and the Echocardiographic laboratory, Dana Hospital for Childrer?, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel Objective: The purpose of this prospective study was to evaluate whether intracardiac echogenic foci (ICEF) are related to impairment of ventricular performance. Study Methods: 3744 low risk patients were prospectively evaluated by the same ultrasonographer. A 4-chamber view of the heart and the cardiac outlet of the great vessels were demonstrated in all fetuses. ICEF were defined as an hyperechogenicity located on the chordae tendinae. Fetuses with ICEF underwent further full echocardiographic evaluation. These fetuses were compared to a control group of 167 fetuses without any apparent cardiac pathology who underwent a full echocardiographic evaluation due to the mother request. Neonates were clinically examined, and referred for an additional echocardiographic evaluation only if a clinical suspicion of cardiac impairment arose. Results: Of the 3744 patients in the study group, 138 fetuses (3.7%) presented with ICEF. The majority of the ICEF (78%) were located in the left ventricle, 18% were located in the right ventricle and 4% were bilateral. Of the 138 fetuses in this group, there was one case (0.7%) of pulmonic stenosis in a twin gestation. The co-twin did not demonstrate any ICEF. There was no other cardiac malformation or dysfunction in the other fetuses. Of the 167 fetuses in the control group, there was one case of fetal bicuspid aortic valve. There was no statistical significance between the 2 groups. Conclusions: We conclude that the finding of ICEF is not correlated with cardiac dysfunction. However, these lesions should be carefully differentiated from rhabdomyoma or teratoma
P4.18.08 MEASUREMENTS OF OBSTETRICS CONJUGATE, THE SHORTEST ANTEROPOSTERIOR DIAMETER OF THE PELVIC INLET, AND PELVIC APERTURE ANGLE BY ULTRASONOGRAPHIC TOMOGRAPHY Mitsuhiro Yoshinaza’, M. Katanozaka’, K. Fuchiwaki ‘, Y. Nagata’. Kagoshima University Hospital, 8-35-l Sakuragaoka, Kagoshima, Japan; 2Fuchiwaki Ladies Clinic, Miyakonojou City, Japan. Objectives: To determine the usefulness of the measurements of ultrasonographic obstetrics conjugate (UOC), the shortest anteroposterior diameter of the pelvic inlet(UAPD), and pelvic aperture angle(UPA) for the assessment of dystocia. Study Methods: Subjects were 165 primigravida women, who had delivered at the Dept of OBIGYN, Kagoshima University Hospital, between January 1997 and August 1999. At 36 to 40 weeks of gestational age, fetal biparietal diameter (BPD), maternal UOC, UAPD, and UPA were measured by transabdominal ultrasonographic tomography. Relationship between these variables and dystocia was investigated retrospectively. Results: Mean value of UAPD was 13.1 m} 0.9 (range, ll.lm\15.1 cm). Mean difference in UAPD and BPD (UAPDm\BPD) was 3.8 m} 0.8 (range, 1.8m\5.9 cm). Of 21 women with UAPDm\BPD (_ 3.0 cm), 13 women (61.9%) underwent cesarean deliveries because of cephalopelvic disproportion (CPD). Mean value of UPA was 88.3 m} 8.8m (range, 65
THURSDAY,
SEPTEMBER
to 115m ). Of 24 women with UPA (_80m ), 9 women (37.5%) underwent cesarean deliveries because of CPD. One hundred twentythree women with both UAPDm\BPD (> 3.0 cm) and UPA (> 80m ), only two women (1.6%) underwent cesarean deliveries. Cesarean rate in these women was significantly lower than that in women with UAPDm\BPD (_ 3.0 cm) or UPA (_ 80m ) (P < 0.001). Conclusions: Based on these results, we conclude that ultrasonographic measurements of UOC, UAPD, and UPA are useful to predict the dystocia.
P4.18.09 OBSTRUCTIVE UROPATHlES A. Patil, H. Divakar, P. Chitra, Divakars Hospital, BTM Layout, Bannerghatta Road, Bangalore, Karnataka, India, 560076. Objectives: To determine the incidence of urinary tract abnormalities detected in the presence of mild to moderate fetal renal pelvis dilatation. Study Materials: 1200 routine prenatal mid trimester ultrasound examinations were performed over 2 years (January 1998 to December 1999). Results: 48 (4%) cases showed mild renal pelvis dilatation (greater than or equal to 4 mm). Of these 29 cases showed regressive patterns, 11 cases showed a stable pattern and 8 cases showed an evolutive pattern on follow up scans. In the presence of an evolutive pattern 6 cases showed presence of urinary tract obstruction (2 cases of unilateral PUJ obstruction, 1 case of bilateral PUJ obstruction, 2 cases of posterior urethral valve, 1 case of multicystic kidney). Obstetric management decisions were mainly based on routine fetal surveillance and AFI measurements, the liquor volume being used as indirect evidence of fetal renal function. Neonatal follow up and definitive management of cases will be presented. Conclusion: Measurements of the anteroposterior diameter of the fetal renal pelvis and assessment of the degree of caliectasis does provide important Clinical information that permits early and effective postnatal management.
P4.18.10 PREDICTING RISK OF PRE-ECLAMPSIA BY QUANTITATIVE ASSESSMENT OF DIASTOLIC NOTCH IN UTERINE ARTERY FLOW VELOCITY WAVEFORM A. Ohkuchi (l), H. Minakami (l), H. Mori (2), T. Nakano (2), M. Tateno (3), I. Sato (1) (1) Dept. OBIGYN, Jichi Medical School, Tochigi, Japan. (2) Dept. OBIGYN, Toyama Prefectural Central Hospital, Toyama, Japan. (3) Dept. OBIGYN, Toyama Red Cross Hospital, Toyama, Japan. Objectives: We have developed a new quantitative index, the notch depth index (NDI). We evaluated the association of the ND1 with the risk of pre-eclampsia, and compared its clinical utility with that of other indices, the uterine artery resistance index (RI) and the AC ratio. Study Methods: Uterine artery color Doppler ultrasound was performed in 288 consecutive healthy pregnant women at 20.2e2.0 (range, 16.0 to 23.9) weeks of gestation. The ND1 represents the depth of the early diastolic notch divided by the maximal diastolic velocity. Results: Nine (3.1%) of the 288 women developed pre-eclampsia. The ND1 was associated with subsequent onset of pre-eclampsia. The optimal cutoff value for the ND1 in predicting pre-eclampsia was 0.14, which gave a sensitivity, specificity, and a positive predictive value (PPV) of 67%, 93%, and 22%, respectively. The PPV of the NDI, 22%, was the largest of the three indices evaluated (12% for he RI and 16% for the AC ratio). The relative risk for pre-eclampsia in women with 2 the optimal cutoff value of the RI, AC ratio and the ND1 was 9.7 [95% CI, 2.5-3.71, 19.2 [4.2-911, and 19.2 [5.1-711, respectively. The ND1 of 0.14 improved the PPV of 18% determined by the presence of notches in bilateral uterine arteries. Conclusions: The ND1 value in the second trimester was associated with the onset of pre-eclampsia, and was more useful clinically in predicting pre-eclampsia than were two conventional indices.
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