Twin pregnancy suspected before implantation.

A case is reported in which the diagnosis of twin pregnancy was suspected by the appearance of 2 follicles on ultrasound examination and by high levels of plasma estradiol and progesterone.

A safe method of amniocentesis for lecithin/sphingomyelin determination in late pregnancy using ultrasound.

Two hundred consecutive amniocenteses for lecithin/sphingomyelin (L/S) determination in late pregnancy are reviewed. These procedures were performed under ultrasonic control before induction of labor or elective cesarean section in a prospective study to determine a safe method for aminocentesis. Complications included 3 failures, 14 blood-stained samples, 2 cases of labor occuring within 24 hours after amniocentesis, and 1 maternal abdominal wall hematoma. There was no cases of perinatal morbidity or mortality. It is proposed that this is a safe method of abdominal amniocentesis for L/S determination in late pregnancy.

Assessment of ovulation by ultrasound and plasma estradiol determinations.

The timing of ovulation was studied daily during the periovular period in 19 women attending an artificial insemination clinic during 24 menstrual cycles; B-mode ultrasound examination and plasma estradiol (E2) determinations were used. The maximum diameters of the ovarian follicles and the peak plasma E2 determinations all occurred within 2 days prior to and including the day of ovulation, as determined by conventional means, in the 12 normal cycles studied. The average values on the day prior to ovulation (day -1) for maximum follicle size and peak E2 determination were 2.5 cm and 1660 pmole/liter, respectively. Two definite ultrasonic patterns were noted after ovulation: The follicle either disappeared or filled with internal echoes. It is concluded from the preliminary study that ultrasound examination and plasma E2 determinations are equally effective in predicting the time of ovulation.

Effects of clomiphene administration on ovarian function as measured by estradiol and ultrasound.

The growth and rupture of the graafian follicle were studied in 23 women during 40 cycles (20 spontaneous, 20 clomiphene-induced) by the estimation of plasma estradiol levels and ultrasound scan. The mean preovulatory estradiol peak level was 415 pg/ml in spontaneous cycles and 626 pg/ml after clomiphene administration when one follicle was present. Ultrasonic examination revealed the presence of more than one developing follicle in one of 20 spontaneous cycles, and in 11 of 20 cycles after clomiphene treatment. The determination of follicle size and number by ultrasound scan during ovulation induction by the routinely used starting dosage of clomiphene has revealed a previously unrecognized incidence of ovarian overstimulation, and may allow the rationalization of ovulation induction regimens.

Assessment of ovulation by ultrasound and estradiol levels during spontaneous and induced cycles.

Both Graafian follicle growth and subsequent ovulation were studied in 45 menstrual cycles of 28 patients by the estimation of plasma estradiol levels and by the measurement of follicle size and number by ultrasound. Twenty spontaneous ovulatory cycles were studied as controls compared with twenty cycles in which ovulation was induced by clomiphene and five cycles in which ovulation was induced by human pituitary gonadotropin. The means of the peak estradiol levels during the cycles in which one follicle was present were 1553.1 +/- 87.8 pmoles/liter in the spontaneous cycles and 2296.8 +/- 163.4 pmoles/liter in the clomiphene-treated cycles. Ultrasound was shown to be complementary to endocrine profiles because the number and diameter of Graafian follicles could be measured accurately by this technique.

An experience of laparoscopic and transvesical oocyte retrieval in an in vitro fertilization program.

Successful pregnancies have been achieved after in vitro fertilization of oocytes obtained by an ultrasound-guided transvesical approach, as well as with the traditional laparoscope. With the use of the same laboratory facilities, success rates for each retrieval method were evaluated in an established in vitro fertilization program. There was a significantly increased cancellation rate and a decrease in oocyte/follicle rate in the transvesical group, but there was a greater fertilization rate with possible improved embryo quality. Although the transfer rates were similar, the pregnancy rate appeared lower in the transvesical group. A valid comparison of these data is not possible because the two groups are dissimilar for factors known to influence oocyte development and recovery. Different criteria were applied to patient selection and treatment, and operation expertise differed between the two groups.

The value of ultrasound, gonadotropin, and estradiol measurements for precise ovulation prediction.

The exact prediction of ovulation is becoming more important in the management of infertile women. Graafian follicle diameter, measured by ultrasound and plasma follicle-stimulating hormone, luteinizing hormone, and estradiol levels were compared retrospectively as predictors of ovulation in 14 normal women in whom ovulation was dated by conventional ultrasound techniques. Follicle diameter was found to be a better predictor of the anticipated time of ovulation than endocrine estimations for short-term as well as long-term predictions in normal women. The relationship between follicle diameter and plasma estradiol for each day before ovulation was linear but contained a great amount of scatter, suggesting that the assessment of normality of follicular development in infertile women may not be possible with the use of these parameters.

Fetal head injury following motor vehicle accident; an unusual case of intrauterine death.

This case report documents fetal death in utero at 30 weeks' gestation due to subdural and subarachnoid haemorrhages, resulting from a motor vehicle accident in which the mother sustained 'seat belt' and facial injuries. There was no evidence of placental abruption. The causes of fetal deaths in utero following maternal involvement in motor vehicle accidents are discussed.

A simple geometric method for determining fetal weight in utero with the compound gray scale ultrasonic scan.

A method to estimate intrauterine fetal weight by calculating fetal volume from simple parameters measured on echograms is described. The comparison between assesed weight of 50 fetuses and actual birth weight is presented.

Parathyroid sonography: a useful aid to preoperative localization.

Parathyroid sonography was used to identify 19 of 23 glands enlarged to over 5 mm in transverse diameter in 22 patients presenting with hyperparathyroidism, both primary and secondary. The false positive and false negative rates were 5 percent and 6 percent, respectively.

Conservative management of pelvic abscess in recurrent pelvic inflammatory disease.

The recent incidence of acute-on-chronic pelvic inflammatory disease, with associated abscess formation, has dramatically increased. Recurrent abscess formation in chronic pelvic inflammatory disease that fails to respond to maximal antibiotic treatment has been traditionally treated by open surgical drainage, frequently accompanied by pelvic clearance.With the development of techniques associated with in vitro fertilization, treatment can now be effected allowing conservation of fertility. This paper describes 12 cases of ultrasound-directed transvaginal fine-needle aspiration of pelvic abscess. A positive outcome occurred in all patients, thus avoiding major surgery.

Ultrasonic signs of imminent ovulation.

Two consistent signs of imminent ovulation in the Graafian follicle have been identified using ultrasound. These signs are a line of decreased reflectivity around the follicle and a crenation pattern within the follicle. The signs may be useful in programs such as in vitro fertilization and artificial insemination, in which timing of ovulation is critical.

A review of 2,003 consecutive amniocenteses performed under ultrasonic control in late pregnancy.

A review of 2003 consecutive amniocenteses performed in late pregnancy under ultrasonic control is presented. No perinatal mortality was encountered. On this evidence the method described is suggested to be the safest available for obtaining liquor in late pregnancy.

Preoperative parathyroid identification by ultrasonic scan.

A preliminary report of the use of ultrasonic scans to locate parathyroid tissue before neck exploration is presented. Three patients suffering from hyperparathyroidism had abnormal parathyroid tissue located before surgery. These findings were confirmed at operation. The role of ultrasonic scans of the neck before exploration is discussed.

Transvaginal pulsed Doppler ultrasound assessment of blood flow to the corpus luteum in IVF patients following embryo transfer.

The waveforms of vessels supplying the ovaries of women on an in-vitro fertilization (IVF) programme were studied using transvaginal B-mode and Doppler ultrasound. There were 125 scans recorded in 65 women at weekly intervals from 3 days after embryo transfer or 5 days after gamete intrafallopian transfer (GIFT) until confirmation of pregnancy or onset of menses. At each examination the signals obtained from vessels supplying the ovaries were recorded and quantified using a resistance index (RI). Fifteen patients became pregnant of whom one has subsequently miscarried. There was a highly significant difference in the RI values between patients who became pregnant and those who did not; no patient who became pregnant had a RI greater than 0.5. Oestrogen to progesterone ratios were calculated in the subgroup of non-pregnant patients and there was no correlation between these values and the RI values. This new technique enables prediction of IVF treatment failure earlier than has been reported previously and may reflect the inadequacy of the corpus luteum.

Oocyte pickup by laparoscopy replaced by transvaginal aspiration in an in vitro fertilization program.

The results of laparoscopic (lap) and transvaginal (TV) oocyte pickups (OPUs) performed concurrently for in vitro fertilization in 232 consecutive treatment cycles have been reviewed. The patients were compared for age, preoperative estradiol concentration, luteal-phase support, and number of follicles aspirated and were found to be similar but were not matched for cause of infertility. The lap OPU group had more oocytes recovered per follicle aspirated (P less than 0.001), but because of a lower fertilization rate (P less than 0.01), the number of embryos transferred was similar. Nevertheless, more (P less than 0.05) pregnancies occurred in the TV OPU group. Patients were subgrouped so that comparisons of patients with the same cause of infertility, tubal disease alone, were considered. This showed that the pregnancy rate was still higher in the TV OPU group (P less than 0.05). TV OPU was less painful and not associated with increased morbidity, and since the data suggest that TV OPU was at least as successful as lap OPU, it is recommended that all oocyte pickups in the future be performed transvaginally.