Residential greenness and hair cortisol levels during the first trimester of pregnancy.

BACKGROUND AND AIM: Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel. METHODS: Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates. RESULTS: After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (-0.27 95% CI: -0.44; -0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status. CONCLUSION: Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.

Fertility Treatment Outcomes After Follicle Tracking With Standard 2-Dimensional Sonography Versus 3-Dimensional Sonography-Based Automated Volume Count: Prospective Study.

OBJECTIVES: The use of sonography-based Automated Volume Count (SonoAVC; GE Healthcare, Kretz, Zipf, Austria) leads to substantially lower intraobserver and interobserver variability with a considerable advantage in time gain for both the physician and patient. It offers the possibility of continuous training and standardization of follicular monitoring. Manual and automated follicular measurements during in vitro fertilization (IVF) are reported to be comparable during gonadotropin-releasing hormone (GnRH) agonist treatment. The aim of our study was to evaluate the effect of follicle tracking with 3-dimensional (3D) SonoAVC on treatment outcomes in GnRH antagonist IVF cycles. METHODS: A prospective trial included 54 women undergoing their first to fourth GnRH antagonist IVF cycles. Follicle tracking from the initiation of ovarian stimulation until the day of oocyte retrieval and timing of oocyte retrieval was done either by conventional 2-dimensional (2D) sonography or 3D SonoAVC (open-labeled parallel assignment). In both groups, recombinant human chorionic gonadotropin was injected when there were at least 3 leading follicles measuring 17 mm. The primary outcome was the oocyte maturation rate, and secondary outcomes were the fertilization rate and clinical pregnancy rate. RESULTS: The number of retrieved oocytes, number and rate of mature oocytes, fertilization rate, and clinical pregnancy rate were similar for 2D sonography and 3D SonoAVC. On a multivariate regression analysis, the use of 3D sonography was not a significant independent predictor of mature oocytes or clinical pregnancy rates. CONCLUSIONS: Follicle tracking with 3D sonographic follicular volume measurements does not achieve better fertility outcomes than standard 2D sonography.

Isolated Fallopian Tube Torsion: A Unique Ultrasound Identity or a Serial Copycat?

OBJECTIVES: To report the preoperative ultrasound (US) signs of isolated fallopian tube torsion in surgically verified cases and to estimate whether preoperative US detection of this condition can be improved. METHODS: The charts of 27 women with a surgical diagnosis of isolated fallopian tube torsion at a tertiary medical center from 2005 to 2016 were retrospectively reviewed. Data were collected from the electronic database of the US unit and compared with the surgical findings. RESULTS: Isolated fallopian tube torsion was correctly diagnosed by US before surgery in 8 of the 27 women (29.6%). In the remainder, the US signs were attributed to torsion of the ovary or the entire adnexa (n = 13), or no torsion was suspected (n = 6). Fallopian tube edema was listed as a US finding in 7 patients, of whom 5 had a correct diagnosis of isolated fallopian tube torsion. The presence of a paraovarian cyst concomitant with normal-appearing ovaries was assumed by US in 5 of the 8 cases that were accurately diagnosed as isolated fallopian tube torsion. The most misinterpreted US finding was an ovarian cyst (suspected in 10 patients and verified at surgery in 2). Absence of blood flow was described in 12 women, of whom 5 had an accurate diagnosis of isolated fallopian tube torsion. Six of the patients with a correct US diagnosis were adults (37.5% of total adults), and 2 were adolescents (18.2% of total adolescents). CONCLUSIONS: The US diagnosis of isolated fallopian tube torsion is challenging. A high index of suspicion is necessary to improve its detection, especially when there are possible US signs of torsion in the presence of a normal-appearing ovary.

Cytogenetic analysis in fetuses with late onset abnormal sonographic findings.

OBJECTIVE: To determine the rate of chromosomal cytogenetic abnormalities in fetuses with late onset abnormal sonographic findings. DESIGN: Retrospective cohort of women who underwent amniocentesis at or beyond 23 weeks of gestation, for fetal karyotype and chromosomal microarray analysis, indicated due to late onset abnormal sonographic findings. RESULTS: All 103 fetuses had a normal karyotype. Ninety-five women also had chromosomal microarray analysis (CMA) performed. The detection rate of abnormal CMA (5/95, 5.3%) was similar to that of women who underwent amniocentesis due to abnormal early onset ultrasound findings detected at routine prenatal screening tests during the first or early second trimester (7.3%, P=0.46) and significantly higher than that for women who underwent amniocentesis and CMA upon request, without a medical indication for CMA (0.99%, P<0.0001). CONCLUSIONS: Late onset sonographic findings are an indication for amniocentesis, and if performed, CMA should be applied to evaluate fetuses with late onset abnormal sonographic findings.

Prediction of fetal loss by first-trimester crown-rump length in IVF pregnancies.

OBJECTIVE: To evaluate the association between small crown-rump length (CRL) and fetal loss ≤22 weeks in IVF pregnancies. METHODS: A retrospective analysis of prospectively collected data at a university-affiliated medical center. All singleton IVF pregnancies within a 5-year period, with a live embryo on first-trimester ultrasound and verified pregnancy outcome were included. Rates of fetal loss ≤22 weeks were compared between pregnancies with a CRL ≤tenth percentile and above the tenth percentile of our population. RESULTS: Overall, 397 pregnancies met inclusion criteria. Ninety-five percent of CRL measurements were performed at 40-80 gestational days. All live-embryo's CRL measurements, from 40 to 80 mm, were plotted against expected gestational age (in 5-day clusters), with calculation of the tenth percentile for every gestational age. Total of 64 pregnancies had CRL ≤tenth percentile for gestational age. The rate of fetal loss in this group was significantly higher than in pregnancies with CRL >tenth percentile (17.2 vs. 6.6%, p = 0.005, OR = 2.93, 95% CI 1.2-6.7). In both groups, the majority of fetal losses occurred ≤10 weeks of gestation. CONCLUSION: In IVF pregnancies with a live embryo, a small CRL at 40-80 days' gestation may predict fetal loss. Repeated ultrasound should be considered after 1-2 weeks.

Diagnosis of deep pelvic masses on a gynaecology service: Trans-vaginal ultrasound-guided needle aspiration of pelvic solid and cystic lesions.

OBJECTIVES: Women with undiagnosed pelvic lesions are often referred for evaluation and treatment. Transvaginal ultrasound-guided fine needle aspiration (TVUS-FNA) biopsy can assist in making management decisions. We describe our experience with this modality. METHODS: We performed a retrospective chart review of all women who had a TVUS-FNA biopsy between January 2004 and December 2014. Charts were reviewed for clinicopathologic information. The pathologic results of the TVUS-FNA were compared with the final diagnosis. RESULTS: Fifty-nine women underwent TVUS-FNA; the median age was 66 years (range 27-85). Thirty-three lesions were evaluated by fine-needle aspiration biopsy of the solid structure and 26 by aspiration of fluid for cytology. Pathologic feasibility rate was 88% (52/59). Of those with evaluable tissue, the sensitivity of the procedure was 100% and the specificity 92%. Considering the seven inconclusive results, the procedure had sensitivity of 88% (29/33) and specificity of 88% (23/26). Overall accuracy of TVUS-FNA for this patient cohort was 85%. No patient characteristics were found to distinguish between accurate and inaccurate or inconclusive TVUS-FNA result. No complications were noted. CONCLUSIONS: TVUS-FNA offers an excellent modality for the diagnosis and management of deep pelvic lesions otherwise not amenable for histologic evaluation.

Nonvisualization of the Fetal Gallbladder: Can Levels of Gamma-Glutamyl Transpeptidase in Amniotic Fluid Predict Fetal Prognosis?

OBJECTIVE: In cases of nonvisualization of the fetal gallbladder (NVFGB), we investigated whether amniotic fluid levels of gamma-Glutamyl transpeptidase (GGTP) can distinguish normal development or benign gallbladder agenesis from severe anomaly such as biliary atresia. METHODS: This is a retrospective cohort study of pregnancies in which the gallbladder was not visualized in the second-trimester fetal anatomy scan. Levels of GGTP in amniotic fluid were analyzed prior to 22 weeks of gestation by amniocentesis. Data were collected regarding other fetal malformations, fetal karyotype, and screening results for cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations. RESULTS: Of 32 cases of NVFGB, 27 (84%) had normal GGTP levels and a normal CFTR gene screening, and 1 of them had an abnormal karyotype. Three of the 5 cases with low GGTP were diagnosed with extrahepatic biliary atresia, proven by histopathological examination following termination of pregnancy. The fourth case had hepatic vasculature abnormality and the fifth isolated gallbladder agenesis. In 22 of 32 cases (68.7%), the gallbladder was detected either later in pregnancy or after delivery. CONCLUSION: The findings support low levels of GGTP in amniotic fluid, combined with NVFGB, as a sign of severe disease, mainly biliary atresia. Normal GGTP levels, concomitant with isolated NVFGB, carry a good prognosis.

Long-Term Follow-Up of Chemotherapy-Induced Ovarian Failure in Young Breast Cancer Patients: The Role of Vascular Toxicity.

BACKGROUND: We previously reported that chemotherapy-induced ovarian toxicity may result from acute vascular insult, demonstrated by decreased ovarian blood flow and diminished post-treatment anti-Müllerian hormone (AMH) levels. In the present study, we report the continuous prospective evaluation of ovarian function in that cohort. METHODS: Patients (aged <43 years) with localized breast cancer were evaluated by transvaginal ultrasound prior to initiation of chemotherapy, immediately at treatment completion, and at 6 and 12 months after treatment cessation. Doppler flow velocity indices of the ovarian vasculature (resistance index [RI], pulsatility index [PI]) were visualized. Hormone markers of ovarian reserve were assessed at the same time points. RESULTS: Twenty patients were enrolled in the study. Median age was 34 ± 5.24 years. Ovarian blood flow was significantly reduced immediately following chemotherapy (both RI and PI; p = .01). These parameters were partially recovered at later points of assessment (6 and 12 months after treatment); patients aged <35 years significantly regained ovarian blood flow compared with patients aged >35 years (p < .05). AMH dropped dramatically in all patients following treatment (p < .001) and recovered in only 10 patients. Hormone markers of ovarian reserve shortly after chemotherapy depicted a postmenopausal profile for most patients, accompanied by related symptoms. Follicle-stimulating hormone (FSH) levels recovered in 14 of 20 patients and significantly returned to the premenopausal range in patients aged <35 years (p = .04); 10 of 20 resumed menses at 12 months. The pattern of vascular impairment was lessened in patients treated with a trastuzumab-based protocol, although results did not reach statistical significance (p = .068). CONCLUSION: Continuous prospective evaluation of ovarian vasculature and function in a cohort of young patients during and after chemotherapy indicated that ovarian toxicity may derive from acute vascular insult. Age may affect whether patients regain ovarian function, whereas recovery of blood flow and premenopausal FSH levels at later assessment was notable in patients aged <35 years. IMPLICATIONS FOR PRACTICE: This study explored the role of vascular toxicity in mediating ovarian impairment and recovery following chemotherapy. Continuous prospective evaluation of ovarian vasculature and function in a cohort of young patients during and after chemotherapy indicated that ovarian toxicity may derive from acute vascular insult. Future studies are warranted to further characterize patterns of vascular toxicity of various chemotherapies in clinical practice and to assess the role of chemotherapy-induced vascular toxicity for specific end organs such as the ovary with systemic vascular effect. Elucidating the cause of impairment may facilitate development of measures to minimize vascular toxicity and consequences of acute vascular insult.

Prenatal sonographic predictors of postnatal pyeloplasty in fetuses with isolated hydronephrosis.

OBJECTIVE: To define prenatal sonographic predictors of ureteropelvic junction obstruction requiring postnatal pyeloplasty, in fetuses with isolated hydronephrosis. METHODS: Retrospective data on prenatal sonographic parameters were compared between patients who had been diagnosed prenatally with hydronephrosis and either underwent postnatal pyeloplasty for ureteropelvic junction obstruction (n = 39) or were treated conservatively (n = 30). RESULTS: Significant differences between the surgically and conservatively treated patients were found for mean anterior-posterior renal diameter (22.8 ± 8.6 vs 14.2 ± 5.9 mm, respectively, p < 0.0001) and parenchymal thickness (5.9 ± 2.8 vs 8.1 ± 2.6 mm, p = 0.009). Anterior-posterior diameter >14 mm was the best single predictor of the need for surgery (area under the ROC curve, 0.817), with sensitivity 77%, specificity 69%, positive predictive value (PPV) 77% and negative predictive value (NPV) 69% (ß = 1.17, 95%CI = 1.07-1.28, p < 0.001). Mean ratio of anterior-posterior diameter to parenchymal thickness was significantly higher in the postnatal pyeloplasty group (5.4 ± 4.5 vs 2.1 ± 1.4, p = 0.0001). A ratio >2.1 had a sensitivity of 87% and specificity of 65% for the need for surgery (area under the curve 0.822, PPV 79%, NPV 77%; ß = 1.92, 95%CI = 1.16-3.17, p < 0.001). CONCLUSION: In cases of prenatal isolated hydronephrosis, the pelvic anterior-posterior diameter and parenchymal thickness may predict the need for postnatal pyeloplasty. A ratio of >2.1 of pelvic anterior-posterior diameter to parenchymal thickness suggests ureteropelvic junction obstruction and supports the use of more intensive prenatal and postnatal surveillance.

The role of cervical length in women with threatened preterm labor: is it a valid predictor at any gestational age?

OBJECTIVE: To determine whether the predictive accuracy of sonographic cervical length (CL) for preterm delivery (PTD) in women with threatened preterm labor (PTL) is related to gestational age (GA) at presentation. STUDY DESIGN: A retrospective cohort study of all women with singleton pregnancies who presented with PTL at less than 34 + 0 weeks and underwent sonographic measurement of CL in a tertiary medical center between 2007 and 2012. The predictive accuracy of CL for PTD was stratified by GA at presentation. RESULTS: Overall, 1077 women who presented with PTL have had sonographic measurement of CL and met the study inclusion criteria. Of those, 223 (20.7%) presented at 24 + 0-26 + 6 weeks (group 1), 274 (25.4%) at 27 + 0-29 + 6 weeks (group 2), 283 (26.3%) at 30 + 0-31 + 6 weeks (group 3), and 297 (27.6%) at 32 + 0-33 + 6 weeks (group 4). The overall performance CL as a predictive test for PTD was similar in the 4 GA groups, as reflected by the similar degree of correlation between CL with the examination to delivery interval (r = 0.27, r = 0.26, r = 0.28, and r = 0.29, respectively, P = .8), the similar area under the receiver-operator characteristic curve (0.641-0.690, 0.631-0.698, 0.643-0.654, and 0.678-0.698, respectively, P = .7), and a similar decrease in the risk of PTD of 5-10% for each additional millimeter of CL. The optimal cutoff of CL, however, was affected by GA at presentation, so that a higher cutoff of CL was needed to achieve a target negative predictive value for delivery within 14 days from presentation for women who presented later in pregnancy. The optimal thresholds to maximize the negative predictive value for delivery within 14 days were 36 mm, 32.5 mm, 24 mm and 20.5 mm for women who presented at 32 + 0 to 33 + 6 weeks, 30 + 0 to 31 + 6 weeks, 27 + 0 to 29 + 6 weeks and 24 + 0 to 26 + 6, respectively. CONCLUSION: CL has modest predictive accuracy in women with threatened PTL, regardless of GA at presentation. However, the optimal cutoff of CL for the purpose of clinical decision making in women with PTL needs to be adjusted based on GA at presentation.

Fetal sex and intrauterine growth patterns.

OBJECTIVES: To analyze the effect of fetal sex on intrauterine growth patterns during the second and third trimesters. METHODS: We conducted a cross-sectional study of women with uncomplicated singleton pregnancies who underwent sonographic fetal weight estimation during the second and third trimesters in a single tertiary center. The effect of fetal sex on intrauterine growth patterns was analyzed for each of the routine fetal biometric indices (biparietal diameter, head circumference, occipitofrontal diameter, abdominal circumference, and femur length) and their ratios. Sex-specific regression models were generated for these indices and their ratios as a function of gestational age. Sex-specific growth curves were generated from these models for each of the biometric indices and their ratios for gestational weeks 15 to 42. RESULTS: Overall, 12,132 sonographic fetal weight estimations were included in the study. Fetal sex had an independent effect on the relationship between each of the biometric indices and their ratios and gestational age. These effects were most pronounced for biparietal diameter (male/female ratio, 1.021) and the head circumference/femur length and biparietal diameter/femur length ratios (male/female ratios, 1.014 and 1.016, respectively). For the head measurements, these sex-related differences were observed as soon as the early second trimester, whereas for abdominal circumference, the differences were most notable during the late second and late third trimesters. CONCLUSIONS: Female fetuses grow considerably slower than male fetuses, and these differences are observed from early gestation. However, the female fetus is not merely a smaller version of the male fetus, but, rather, there is a sex-specific growth pattern for each of the individual fetal biometric indices. These findings provide support for the use of sex-specific sonographic models for fetal weight estimation as well as the use of sex-specific reference growth charts.

Chemotherapy-induced ovarian failure as a prototype for acute vascular toxicity.

BACKGROUND: Chemotherapy-related amenorrhea is a frequent side effect observed in young breast cancer patients. Studies in mice revealed that chemotherapy-induced gonadal toxicity may result from vascular damage. We prospectively evaluated ovarian blood flow and function in young breast cancer patients following chemotherapy. METHODS: Young female patients with localized breast cancer undergoing adjuvant or neoadjuvant anthracycline- or taxane-based chemotherapy were evaluated using transvaginal ultrasound prior to initiation of and immediately after cessation of chemotherapy. Doppler-flow velocity indices of the ovarian vasculature-resistance index (RI), pulsatility index (PI)-and size measurements were visualized. Hormonal profiles, anti-Müllerian hormone (AMH) levels, and menopausal symptoms were assessed at the same time points. RESULTS: Twenty breast cancer patients were enrolled in the study. The median age was 34 ± 5.24 years. Ovarian blood flow was significantly reduced shortly following chemotherapy: RI decreased by 52.5% and PI decreased by 24.2%. The mean ovarian size declined by 19.08%. Patients who were treated with sequential chemotherapy experienced further reductions in ovarian blood flow and ovarian size after the second sequence. AMH levels dropped dramatically in all patients following treatment. Hormonal profiles after treatment depicted a postmenopausal profile for most patients, accompanied by related symptoms. CONCLUSIONS: Our results may imply a mechanism of chemotherapy-induced ovarian toxicity manifested by decreased ovarian blood flow accompanied by a reduction in ovarian size and diminished post-treatment AMH levels. Based upon our former preclinical studies, we assume that this may derive from an acute insult to the ovarian vasculature and may represent an initial event triggering a generalized phenomenon of end-organ toxicity.

Reference values for fetal penile length and width from 22 to 36 gestational weeks.

OBJECTIVE: Current reference range values for fetal penile growth are based on length measurements. However, methodologies for measuring penile length differ among studies and from the standard technique used in children. We propose that the measurement of penile width may aid in its evaluation. The aim of the study was to create normograms for penile length and width. METHODS: A prospective cross-sectional design was used. One hundred male fetuses at 22 to 36 gestational weeks were included. On ultrasound examination, penile length was measured from tip to base, where the penis joins the scrotum. Penile width was measured at the widest point across the penis. Reference values for the 5th and 95th percentiles were calculated for each gestational week. RESULTS: There was a good correlation between gestational age and penile length (R(2) = 0.606) and width (R(2) = 0.683). The percentile of fetal weight estimation independently affected penile length and width. The interobserver correlation coefficient was 0.939 for length and 0.909 for width. CONCLUSION: Reference range values of fetal penile length and width are presented for 22 to 36 weeks of gestation. These values correlate to gestational age and estimated fetal weight percentile. These reference range measurements may help the evaluation of suspected micropenis.

Correlations between antral follicle count and ultrasonographic ovarian parameters and clinical variables and outcomes in IVF cycles.

AIMS: To assess the correlation between the antral follicle count (AFC) and other ultrasonographic parameters and clinical variables in in vitro fertilization (IVF) cycles. METHODS: Pretreatment ultrasonographic evaluation included AFC (total), large (5-10 mm) and small (2-4 mm) antral follicles, ovarian volume, and ovarian Doppler indices. Data were prospectively uploaded and subsequently analysed in relation to IVF cycle results. RESULTS: The study included 128 women (128 cycles). Analysis of body mass index (BMI) yielded a weak significant correlation with large (5-10 mm) AFC but not with other sonographic variables. AFC was significantly correlated with patient age, ovarian volume, number of retrieved oocytes, total dose of used gonadotropins, peak estradiol, number of top-quality embryos, and number of frozen embryos and marginally correlated with number of aspirated immature oocytes. Lower large (5-10 mm) AFC was the only ovarian parameter associated with oral contraception pretreatment compared to nontreatment, even after adjustment for age and BMI. There was no difference in any of the parameters between short and long IVF cycles. CONCLUSIONS: BMI is only weakly correlated with AFC. Pretreatment with oral contraceptives may be associated with lower AFC. Pretreatment with gonadotropin-releasing hormone agonist (long protocol) does not alter the ultrasonographic ovarian parameters.

Role of fetal length in the prediction of fetal weight.

OBJECTIVES: The purpose of this study was to compare the accuracy of routine fetal biometric indices in the prediction of fetal length and to determine whether more accurate sonographic measures of fetal length can improve the accuracy of fetal weight estimation. METHODS: The accuracy of the common sonographic fetal biometric indices for predicting fetal length was determined using 3689 sonographic weight estimations performed within 3 days before delivery. The fetal length at the time of the sonographic examination was assumed to be equal to the neonatal length, which is routinely measured within 24 hours of delivery. Two new regression models for fetal weight estimation, one with and one without fetal length as an independent variable, were generated to determine the potential contribution of more accurate predictors of fetal length to the accuracy of fetal weight estimation. RESULTS: Abdominal circumference was a significantly more accurate predictor of fetal length (r = 0.732) compared with femur length (r = 0.712), biparietal diameter (r = 0.644), and head circumference (r = 0.661; P < .05), although each of these biometric indices explained only about 50% of the variance in fetal length (R(2) = 0.423-0.548). The addition of fetal length as an independent variable to a birth weight prediction model significantly improved the model's correlation with birth weight(r = 0.917 versus 0.903; P = .006), systematic error (0.2% versus 0.6%; P < .001), random error (6.7% versus 7.5%; P < .001), mean absolute percent error, and the proportion of estimations within 5% and 10% of birth weight. CONCLUSIONS: The correlation between routine biometric indices and fetal length is limited. Identification of new fetal sonographic biometric indices with greater predictive accuracy for fetal length may improve the accuracy of fetal weight estimation.

Sonographic evaluation of kidney parenchymal growth in the fetus.

OBJECTIVE: The aim of the study was to establish a nomogram for renal parenchymal thickness throughout pregnancy. METHODS: One-hundred and twenty-eight healthy women with singleton, well-dated, uncomplicated second- or third-trimester pregnancies were prospectively evaluated for renal parenchymal thickness on routine ultrasound scans. The renal parenchyma was measured in transverse and sagittal sections using predefined criteria. RESULTS: There were no differences in anterior or posterior parenchymal measurements in either plane by fetal sex. On sagittal-section analysis, no differences were noted between the right and left kidneys. A nomogram was established on the basis of the findings. The results showed constant linear growth of the fetal parenchyma during pregnancy. CONCLUSIONS: The normal fetal parenchyma grows at a constant, linear rate throughout pregnancy. The nomogram formulated may serve as a basis of future studies of the correlation of parenchymal thickness with postnatal kidney function in fetuses with urinary tract anomalies.

[What do doctors understand regarding ultrasound safety during pregnancy?].

Ultrasound has a well established record for being a safe procedure during pregnancy. Nevertheless, one should bear in mind the fact that ultrasound is a source of energy with two main bioeffects in tissue: heat and cavitation. These effects are inherent in the physical properties of the ultrasound transducers and have not been shown to be harmful to the developing fetus. The two bioeffects are approximated by the thermal index for heating (TI) and the mechanical index (MI) for cavitation effects. These indices appear clearly on the ultrasound screen, enabling the operator to see if their values are within the normal range. Poor level of knowledge regarding safety issues were found among ultrasound performers both in Israel and the USA. This lack of knowledge is an alarm signal for the health authorities, arousing a demand for the establishment of training programs for all ultrasound end-users.

Small antral follicle count (2-5 mm) and ovarian volume for prediction of pregnancy in in vitro fertilization cycles.

AIMS: To assess the value of antral follicle count (AFC) and other parameters as predictors of pregnancy in in vitro fertilization (IVF). METHODS: In a cohort study, unselected consecutive women in IVF treatment were evaluated. Pretreatment parameters included AFC (subpopulations of small (2-5 mm) and large (5-10 mm) AFC), ovarian volume, and ovarian stroma Doppler indices. RESULTS: The study included 115 women of whom 38 (33%) were pregnant. Total AFC was significantly higher in the pregnant than in the non-pregnant group (13.7 ± 5.8 vs. 11.3 ± 5.3, p = 0.034). On receiver operator characteristic (ROC) curve analysis, the pretreatment variables that were significantly associated with pregnancy were small AFC (2-5 mm), total AFC, and ovarian volume/AFC ratio. Women with a positive score (total AFC >15; small AFC (2-5 mm) >10; ovarian volume in mm(3)/AFC, <1400), had a significantly higher number of retrieved oocytes and a higher pregnancy rate than women with a negative score (12.1 ± 5.1 vs. 8.7 ± 5.0, p = 0.027 and 58.3% vs. 30.1%, p = 0.049, respectively). On multivariate logistic regression analysis, total AFC was the only significant and independent predictor of pregnancy (p = 0.034). CONCLUSION: Pretreatment small AFC and ovarian volume may identify women with a higher probability to achieve pregnancy in IVF.

Sonographic diagnosis of ovarian torsion: accuracy and predictive factors.

OBJECTIVES: The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs. METHODS: The study included 63 women attending an ultrasound unit of a tertiary obstetrics and gynecology department in 2002 through 2008 who had suspected ovarian torsion on sonography and subsequently underwent laparoscopy. RESULTS: Sonography had diagnostic accuracy of 74.6% for ovarian torsion. Abnormal ovarian blood flow and the presence of free fluid were the most diagnostically accurate isolated sonographic signs (positive predictive values, 80.0% and 89.2%, respectively; negative predictive values, 46.2% and 46.2%). Using combinations of sonographic signs yielded higher specificity and positive predictive values and lower sensitivity and negative predictive values for ovarian torsion. The diagnostic accuracy was largely affected by the ultrasound operator (mean ± SD, 78.8% ± 16.0%; range, 60.0%-100%). CONCLUSIONS: In the setting of a specialized ultrasound unit, sonographic diagnosis of ovarian torsion had high (74.6%) accuracy compared with previous reports. The absence of typical sonographic signs does not rule out ovarian torsion, especially when the clinical presentation is suggestive. Basing assessments on multiple sonographic signs, including Doppler evaluation, increases the diagnostic specificity.