Duplex Doppler sonography of the umbilical arteries: predictive value in IUGR and correlation with birth weight.

Forty-three women with either clinically high-risk singleton pregnancies or a predicted fetal weight less than the 10th percentile were studied in their third trimester by duplex Doppler sonography of the free umbilical artery to assess the associations between umbilical arterial flow resistance and intrauterine growth retardation (IUGR) and birth weight. Test criteria included: the greatest (GRI), mean (MRI), and least (LRI) resistive index. The criterion with the strongest association with IUGR (p = 0.001) was the parameter of the LRI predicting IUGR). Linear regression analysis showed a nonsignificant correlation between RI and percentile birth weight, with r2 = 0.05 and p = 0.131. While significant associations can be shown between RI and IUGR, the clinical use of the results of this test should reflect the imprecise nature of these correlations.

Fetal echocardiographic screening for congenital heart disease.

During a 30-month period, 7,531 obstetrical ultrasound examinations were performed on 3,624 fetuses at a community hospital. All fetuses were evaluated for congenital heart disease and 16 complex defects were identified. Only two of the cardiac defects had predisposing clinical factors or an elevated serum alpha-fetal protein. Discovery of cardiac defects in-utero permitted referral of the patients to tertiary care facilities when delivery was desired. This allowed prompt therapy by a pediatric cardiologist or cardiothoracic surgeon, if necessary.

Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria.

Four sonographic diagnostic criteria for appendicitis, (1) any visualization, (2) appendiceal diameter greater than 6.0 mm, (3) muscular wall thickness greater than or equal to 3.0 mm, and (4) presence of a complex mass, were compared in a series of 200 patients clinically suspected of having appendicitis. The diagnosis of appendicitis was confirmed histopathologically and included all forms of appendicitis with mucosal invasion by inflammatory cells. The sensitivities of all the criteria were low (11% to 75%) and the usefulness of this test as a screening procedure is questioned. The combined criteria of an appendix with a muscular wall thickness (MWT) greater than or equal to 3.0 mm and visualization of a complex mass (CM) separate from the adnexa in females proved most useful as a diagnostic test (sensitivity, 68%; specificity, 98%). We conclude that the diagnosis of appendicitis is still difficult, despite the addition of graded compression ultrasound as a diagnostic test. We do not recommend its use as the only screening test, but do recommend it, rather, in a diagnostic role after the initial clinical screening.