Antenatal ultrasonographic features of fetal giant hemangiolymphangioma.

A giant multiseptate cystic mass covering the whole left hemitruncus of fetus was detected by ultrasonography at 23 weeks of gestation. Color and pulsed Doppler ultrasonography revealed marked blood flow in the mass. No other anomaly or chromosomal abnormality was recognized. Although the cystic lesion increased in size with advancing gestation a male infant weighing 4096 g was delivered in good condition at term. Histological examination of the lesion demonstrated hemangiolymphangioma with hyperplasia of both capillaries and lymphoducts. The infant was treated effectively with OK-432 and interferon-alfa-2a.

Is there a human fetal gallbladder contractility during pregnancy?

The purpose of this study was to evaluate whether human fetal gallbladder contractility exists in the second half of pregnancy. Ultrasound examinations were performed on 54 normal pregnant women from 20 to 40 weeks of gestation. Fetal gallbladder volume was monitored every 30 min from 08:00 to 18:00 h in each patient. Maximum gallbladder volume was related linearly with gestational age between 20 and 32-35 weeks of gestation, after which a plateau was observed. Minimum gallbladder volume was unchanged throughout gestation. Functional capacity (maximum volume - minimum volume) of the fetal gallbladder increased linearly with advancing gestation until 32-35 weeks gestation, and thereafter was constant. Contractility rate [(maximum volume - minimum volume/maximum volume)x100] increased curvilinearly with advancing gestation (R(2) = 30.7%, P < 0.0001). The daily change in fetal gallbladder volume showed a typical sinusoidal pattern, and the contractility cycle of gallbladder volume was unchanged during pregnancy (3.1 +/- 0.6 h). These results suggest that there is an apparent gallbladder contractility in human fetuses in utero, and that maternal meals seem not to affect the volume of the fetal gallbladder. Further study is needed to clarify the physiological role of fetal gallbladder contractility during pregnancy.

Intrauterine sonographic measurement of embryonic brain vesicle.

Our purpose was to evaluate embryonic brain vesicle measurements using intrauterine sonography in early first-trimester pregnancy. Fifty-one women about to undergo therapeutic abortion from 7-9.9 weeks gestational age were studied with a specially developed flexible catheter-based high-resolution real-time miniature (2.4 mm in outer diameter) ultrasound transducer (20 MHz). Length, width and height of telencephalon, diencephalon, mesencephalon and rhombencephalon were measured. The normal range of embryonic brain vesicle measurements for each day of pregnancy was determined. Curvilinear relationships were found between the menstrual age and telencephalon height (r(2) = 71.2%), diencephalon length (r(2) = 39. 6%), width (r(2) = 39.4%) and height (r(2) = 48.3%) and mesencephalon length (r(2) = 59.0%) respectively. Linear relationships were found between the menstrual age and telencephalon width (r(2) = 41.4%), mesencephalon height (r(2) = 58.7%) and rhombencephalon length (r(2) = 44.9%), width (r(2) = 56.8%) and height (r(2) = 35.5%) respectively. Telencephalon length and mesencephalon width were constant throughout menstrual age. These results suggest that intrauterine sonography provides accurate embryonic brain measurements in utero. Moreover, intrauterine sonography may become an important modality in future embryological research and in detection of embryonic brain developmental disorders in early first-trimester pregnancy.

Saline infusion contrast intrauterine sonographic assessment of the endometrium with high-frequency, real-time miniature transducer in normal menstrual cycle: a preliminary report.

Normal endometrial texture was visualized using saline infusion contrast intrauterine sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature (2.4 mm outer diameter) ultrasound transducer in primary infertile women (n = 15) with a normal menstrual cycle. All the women had <2 years infertility duration and were studied in proliferative, and early or mid-secretory phases. Before intrauterine sonography, transvaginal sonographic assessment of the endometrium was conducted. The overall image clarity was subjectively compared between intrauterine and transvaginal sonography. Most endometrial textures in both proliferative and secretory phases were viewed more easily with intrauterine rather than transvaginal sonography, and this was especially true with an intrauterine saline infusion technique. Moreover, it was possible to obtain finer image quality of very small endometrial interfacial and internal textures with intrauterine sonography. However, the depth of penetration of the ultrasound beam is only approximately 2 cm, therefore examination of larger pathological endometrial lesions is markedly limited because of the shallow scanning range of the high-frequency transducer. Intrauterine sonography may be a valuable tool in imaging endometrial texture in normal menstrual cycle, and possibly in infertility practice, complementing and not replacing transvaginal sonography.

Laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer for assessment of the Fallopian tube: a preliminary report.

Our purpose was to visualize normal and abnormal Fallopian tubes using laparoscopy-assisted intrapelvic sonography with a specially developed 20 MHz flexible catheter-based high-resolution, real-time miniature (2.4 mm outer diameter) ultrasound transducer in infertile women. A total of 21 women (20 infertile, one with unilateral hydrosalpinx, and one tubal pregnancy) were studied with pelvic saline effusion under laparoscopy. Fimbriae were clearly depicted with a cockscomb-like form in 95% of patients. All ampullae were visualized, and mucosal layers were clearly distinguished from muscle layers in 70% of patients. Scanty intratubal effusion was noted in 50% of patients, and tubal spastic findings were found in 10% of patients. In all, 60% of isthmuses were detected, and mucosal layers were distinguished from muscle layers in 30%. In the subject with hydrosalpinx, the tubal wall was thinner, and it was not possible to distinguish between muscle and mucosal layers. In the subject with a tubal pregnancy, the amniotic membrane and decidua were depicted more clearly than by transvaginal sonography. In conclusion, laparoscopy-assisted intrapelvic sonography with a high-frequency, real-time miniature transducer may be useful in the assessment of tubal texture and function in tubal disorders, possibly in infertility practice.

Clinical application of intrauterine sonography with high-frequency, real-time miniature transducer in gynecologic disorders. Preliminary report.

Our purpose was to determine whether intrauterine sonography with high-frequency, real-time miniature transducer (20 MHz) is useful for the diagnosis of gynecologic disorders. The study consisted of 37 women: 8 normal volunteers, 2 with molar pregnancy, 4 fibromyoma, 4 endometrial polyp, 1 intrauterine adhesion, 1 septate uterus, 5 atypical hyperplasia, 8 endometrial cancer, and 4 with cervical cancer. Comparison of diagnostic efficacy for gynecologic disorders between transvaginal and intrauterine sonography was made. The probe was easily introduced into the endometrial cavity in all patients. No notable complications were encountered. In subjects with a normal uterus, higher resolution for endometrial texture was obtained with intrauterine sonography than with transvaginal scanning. In patients with molar pregnancy, typical vesicular echoes were clearly identified. In patients with fibromyoma, myoma nodules were not clearly visualized because of poor attenuation of ultrasound. In subjects with endometrial polyp, intrauterine adhesion, and septate uterus, intrauterine lesions were clearly identified. In patients with atypical hyperplasia, high echogenicity of the endometrium was characterized. Myometrial invasion of the endometrial cancer was estimated correctly in 6 of 8 patients (75%). Intrauterine sonography could clearly detect early cervical invasion of the cervical cancer in all 4 patients, but transvaginal sonography could not do it. Intrauterine sonography with a high-frequency, real-time miniature transducer might be a useful diagnostic modality in gynecologic disorders, especially in the evaluation of early cervical cancer, endometrial cancer, and possibly in infertility practice.

Intrauterine sonographic assessments of embryonic heart diameter.

Our purpose was to evaluate embryonic heart diameter in early first-trimester pregnancy using intrauterine sonography with a 20 MHz flexible catheter-based high-resolution real-time miniature transducer. A total of 40 women about to undergo therapeutic abortion from 6-9.9 weeks gestational age and one abnormal pregnancy with fetal hydrops at 9 weeks were studied with a specially developed catheter-based high-resolution real-time miniature (2.4 mm outer diameter) ultrasound transducer (20 MHz). A curvilinear relationship was found between the menstrual age and embryonic heart diameter (R2 = 95.7%), and a normal range of embryonic heart diameter for estimating the growth of the embryonic heart during early first-trimester pregnancy was generated. A normogram of menstrual age as predicted by embryonic heart diameter was also established. There was a good curvilinear correlation between embryonic heart diameter and crown-rump length (R2 = 90.1%). The embryonic heart diameter/crown-rump length ratio rapidly decreased from week 6 to week 7, and remained almost constant thereafter. Embryonic heart diameter (5.2 mm) in the case of fetal hydrops at 9 weeks was above the normal range. These results may provide an additional method of estimating gestational age in the early first trimester of pregnancy. In this limited series, a single case of embryonic heart enlargement was demonstrated, suggesting its potential use in the detection of embryonic congestive heart failure.

Assessment of embryonic anatomy at 6-8 weeks of gestation by intrauterine and transvaginal sonography.

Our purpose was to compare the ultrasound visualization of the early first-trimester embryo using transvaginal and intrauterine sonography. In all, 32 women about to undergo therapeutic abortion at 6-8.9 weeks gestation were studied using a specially developed catheter-based, high-resolution, real-time miniature (2.4 mm outer diameter) ultrasonography transducer (20 MHz). Before the intrauterine sonographic procedure was performed, transvaginal sonographic assessment of the embryo was conducted. The parameters evaluated included the ability to visualize anatomical structures and a subjective assessment of the overall image clarity. The ability to view most organs was better with intrauterine sonography compared to transvaginal sonography, and this was especially true for the brain, spine, heart, liver, midgut herniation, extremities, and sacral tail. Moreover, it was possible to obtain finer image quality of very small embryonic structures with intrauterine sonography than with transvaginal sonography. Stomach, spleen, kidney, and bladder could not be depicted with both techniques. One cystic hygroma was diagnosed at 7 weeks 6 days using intrauterine sonography, but not with transvaginal sonography. Intrauterine sonography may provide additional information on the visualization of anatomical structures of the embryo in the early first trimester of pregnancy. In this limited series, one case of cystic hygroma was demonstrated and, thus, there is a potential for its use in the early detection of embryonic malformation. These results suggest that intrauterine sonography may be a valuable tool in imaging the early first-trimester embryo, complementing and not replacing transvaginal sonography in high-risk pregnancies.

Doppler ultrasound in a patient with ovarian Brenner tumor of low malignant potential: comparison with Gray-scale ultrasound, magnetic resonance imaging and tumor marker suggesting malignancy.

We present a postmenopausal patient with giant lower abdominal tumor. Gray-scale ultrasound and magnetic resonance imaging showed typical abnormal morphology suggesting malignancy. The serum CA 125 level was 69 U/ml, and that of CA 19-9 was 2,097 ng/ml. Transvaginal color and pulsed Doppler sonography of the tumor vasculature demonstrated low peak systolic velocity (6.7 cm/s) with low pulsatility (resistance index: 0.49). Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological diagnosis was ovarian Brenner tumor of low malignant potential. Transvaginal Doppler findings seemed to give specific information for the diagnosis in this case.

Intrauterine sonographic assessments of embryonal liver length.

Our purpose was to evaluate embryonal liver length measurement using intrauterine sonography with a specially developed 20 MHz flexible catheter-based high-resolution real-time miniature (2.4 mm outer diameter) ultrasound transducer in early first-trimester pregnancy. A total of 36 women about to undergo therapeutic abortion at 7-9.9 weeks gestational age and one abnormal pregnancy with fetal hydrops at 9 weeks were studied. The normal range of embryonal liver length for each day of pregnancy was determined. A relationship between embryonal liver length and crown-rump length measurements is described. A linear relationship was found between the menstrual age and embryonal liver length (R2 = 93.3%), and a normal range of embryonal liver length for estimating the growth of the embryonal liver during early first trimester pregnancy was generated. A normogram of menstrual age as predicted by embryonal liver length was also generated. Embryonal liver length was curvilinearly correlated with crown-rump length (R2 = 92.3%). Embryonal liver length value (6.4 mm) in a case of fetal hydrops at 9 weeks was above the normal range. These results may provide an additional measurement for the estimation of gestational age in the early first trimester of pregnancy. In this limited series one embryonal liver enlargement was demonstrated and, thus, there is a potential for its use in the detection of embryonal congestive heart failure. The value and potential applications of this new embryonal parameter are discussed.

Mathematical modeling of fetal foot growth: use of the Rossavik growth model.

Growth of the fetal foot has been monitored by foot length (FL), from 12 to 41 weeks menstrual age in 173 normal Japanese fetuses. Growth curve for this parameter has been determined using a Rossavik growth model [p = c(t)k+s(t)]. R2 value of 98.0% was obtained for FL. Variability analysis indicated some progressive increase in variability with fetal age for this parameter. Variability data were used with the growth curve model to determine standard curve for this parameter. This standard curve provides a superior means for evaluating the normal fetal foot growth in the fetus and for assessing menstrual age in utero.

Effect of dehydroepiandrosterone sulfate on fetal middle cerebral artery flow velocity waveforms in term pregnancy.

OBJECTIVE: To investigate whether bolus injection of dehydroepiandrosterone sulfate (DHAS) is associated with changes in fetal middle cerebral artery flow velocity waveforms in term pregnancy. METHODS: Ten normal full-term pregnant women received the administration of a 200-mg intravenous dose of DHAS in 20 ml of 5% dextrose. Ten normal full term pregnant women received 20 ml 5% dextrose as controls. Color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on fetuses in each group before and 10 min, 30 min, 60 min, 90 min. and 120 min after DHAS or dextrose administration. The pulsatility index (PI) values for the middle cerebral artery, and umbilical artery, and fetal heart rate were recorded. RESULTS: In the DHAS group, middle cerebral artery PI decreased from baseline by 24% (p<.05) after 10 min, and the mean reduction was 22% (p<.05) after 30 min. The PI returned to the baseline value 60 min later. In the control group, there was no change in middle cerebral artery PI. No change was found in umbilical artery PI or fetal heart rate in the control or DHAS group. CONCLUSION: DHAS induces a significant decrease in the fetal middle cerebral artery PI, which suggests a possible decrease in fetal cerebral vascular impedance in term pregnancy.

Fetal ophthalmic artery blood flow velocity waveforms.

OBJECTIVE: To evaluate alterations in vascular impedance of the fetal ophthalmic artery (OA) with advancing gestation. STUDY DESIGN: Color Doppler flow imaging and pulsed Doppler ultrasonographic assessment were performed on 28 normal fetuses, at gestational ages ranging from 21 to 40 weeks. The pulsatility index (PI) was calculated for the OA and the middle cerebral artery (MCA). Optimal models for these PI values were determined by regression analysis. A normal range of PI values for both arteries was generated. RESULTS: In the OA, the model showed a parabolic pattern during pregnancy, as was the case for MCA. The predicted PI values for the OA were always lower than those for the MCA. CONCLUSION: Our study is the first to demonstrate alterations in regional vascular impedance of the fetal OA with advancing gestation. These data provide a foundation for the evaluation of fetal ocular circulation in normal and abnormal pregnancies.

Mathematical modeling of fetal organ growth using the Rossavik growth model. V. Cerebellum.

Growth of the fetal cerebellum was monitored by transverse cerebellar diameter (CD) from 14 to 39 weeks menstrual age in 125 Japanese fetuses. The growth curve for this parameter was determine using a Rossavik growth model [p = c(t)k & (t)]. An R2 value of 95.5% was obtained for CD. Variability analysis indicated a progressive increase in variability with fetal age for this parameter. Variability data were used with the growth curve model to determine a standard curve for this parameter. This standard curve provides a superior means to evaluate normal fetal cerebellar growth in the fetus and to identify cerebellar abnormalities in utero.

Effect of maternal hyperglycemia on fetal regional circulation in appropriate for gestational age and small for gestational age fetuses.

The effect of maternal hyperglycemia on fetal regional circulation in appropriate for gestational age and small for gestational age fetuses was evaluated. Color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on 15 appropriate for gestational age and 19 small for gestational age fetuses, ranging from 33 to 40 weeks' gestation before, 60 minutes, and 120 minutes after a maternal 75 g glucose load. The pulsatility index (PI) was calculated for middle cerebral artery, descending aorta, splenic artery, renal artery, femoral artery, and umbilical artery. Simultaneously, maternal plasma glucose concentration was measured. Baseline PI value (1.50 +/- 0.31) for middle cerebral artery in small for gestational age fetuses was significantly lower than that (1.89 +/- 0.37) in appropriate for gestational age fetuses (p < 0.05); however, there were no significant differences in baseline PI values for other arteries in both groups. In appropriate for gestational age fetuses, the mean PI decreased from 1.89 +/- 0.37 to 1.47 +/- 0.33 at 60 minutes, and to 1.55 +/- 0.32 at 120 minutes (p < 0.05), but no changes were found in the other arteries. In small for gestational age fetuses, there was no significant change in PI value for each artery before and after maternal glucose load. Maternal hyperglycemia induces a significant decrease in cerebrovascular resistance in appropriate for gestational age fetuses but not in small for gestational age fetuses. These results provide a foundation for evaluating the effect of maternal hyperglycemia on fetal regional circulation.

Effect of dehydroepiandrosterone sulfate on ophthalmic artery flow velocity waveforms in full-term pregnant women.

The possible effects of dehydroepiandrosterone sulfate on orbital circulation in 14 term pregnant women were examined by color Doppler flow mapping and pulsed Doppler ultrasound assessments of ophthalmic artery blood flow velocities before and 3 minutes after the intravenous drug injection. Blood pressure, heart rate, peak systolic velocity, end-diastolic velocity, time-averaged mean peak velocity, and pulsatility index were studied. Dehydroepiandrosterone sulfate injected intravenously had little effect on blood pressure, heart rate, and peak systolic velocity, increasing (p < 0.02) the mean end-diastolic velocity from 3.7 +/- 1.7 to 4.9 +/- 2.0 cm/s (mean +/- SD) and the mean time-averaged mean peak velocity (p < 0.02) from 9.8 +/- 3.2 to 12.1 +/- 3.9 cm/s (mean +/- SD). The mean pulsatility index decreased simultaneously (p < 0.02) from 2.75 +/- 0.79 to 2.29 +/- 0.58 (mean +/- SD). Dehydroepiandrosterone sulfate vasodilates the ophthalmic artery, increasing blood flows in term pregnant women, and similar changes might occur in other cerebral vessels. It seems that this vasodilative effect of dehydroepiandrosterone sulfate is expected for treatment of preeclampsia.

Ophthalmic artery velocimetry in preeclampsia.

Our objective was to compare ophthalmic artery pulsatility index values from normal pregnant women with those from preeclampsia patients. The ophthalmic artery of 20 normotensive pregnant women, 7 mildly preeclamptic and 2 severely preeclamptic patients was studied once with color Doppler flow imaging and pulsed Doppler ultrasonography after 32 weeks gestation. The peak systolic velocity [49.0 +/- 11.8 (SD) cm/s] in mild preeclampsia was significantly higher (p < 0.0001) than that (32.1 +/- 9.5 cm/s) in normotensive pregnant women, as were the end-diastolic velocity (14.1 +/- 7.7 cm/s vs. 3.7 +/- 1.4 cm/s, p < 0.0001) and time-averaged mean peak velocity (24.4 +/- 10.2 cm/s vs. 10.5 +/- 2.9 cm/s, p < 0.0001). The pulsatility index (1.58 +/- 0.47) in mild preeclampsia was significantly lower (p < 0.0001) than that (2.75 +/- 0.66) in normotensive pregnant women. In the 2 cases of severe preeclampsia, pulsatility index values (case 1: 1.86; case 2: 2.44) in the late stage of the disease process were significantly higher than those (case 1: 1.19; case 2: 1.20) in the early stage. We conclude that mild preeclampsia was associated with a significant decrease in ophthalmic artery vascular resistance, whereas ophthalmic artery vascular resistance in severe preeclampsia increased as the disease process advanced. However, in view of the small number of severe preeclamptic patients, these observations must be considered preliminary.

Effect of dehydroepiandrosterone sulfate on uterine artery flow velocity waveforms in term pregnancy.

OBJECTIVE: To investigate the interrelation between estrogen synthesis by the fetoplacental unit and uteroplacental hemodynamics in term pregnancy. METHODS: Transvaginal color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on ten normal full-term pregnant women before and 3, 5, 10, 30, and 60 minutes after the administration of a 200-mg intravenous dose of dehydroepiandrosterone sulfate (DHAS) in 20 mL of 5% dextrose. Ten normal full-term pregnant women received 20 mL of 5% dextrose as controls. The pulsatility index (PI) values for the uterine artery, heart rate, and mean arterial pressure were recorded. Plasma estradiol (E2) was measured before and 10 minutes after the infusion. RESULTS: In the DHAS group, uterine artery PI decreased from baseline by 26% (P < .05) after 5 minutes, and the mean reduction was 36% (P < .05) after 10 minutes and 15% (P < .05) after 30 minutes. The PI returned to the baseline value 60 minutes later. In the control group, there was no change in uterine artery PI. No change was found in heart rate or mean arterial blood pressure in the control or DHAS groups. The mean plasma E2 increased from 22.3 +/- 6.6 to 56.2 +/- 24.1 ng/mL (P < .05) 10 minutes after the infusion in DHAS subjects, whereas there was no significant change in plasma E2 in the controls. CONCLUSION: Dehydroepiandrosterone sulfate induces a significant decrease in the uterine artery PI, which suggests a possible decrease in uterine vascular impedance in term pregnancy.

Mathematical modeling of fetal organ growth using the Rossavik growth model: III. Cardiac ventricle.

Growth of the fetal cardiac ventricle has been monitored by total cardiac diameter (TCD), left ventricular systolic (LVSD) and diastolic diameter (LVDD), right ventricular systolic (RVSD) and diastolic diameter (RVDD), left ventricular width (LVW), interventricular septal width (IVSW), and right ventricular width (RVW) from 19 to 39 weeks, menstrual age, in 114 normal Japanese fetuses. Growth curves for these parameters have been determined using a Rossavik growth model [P = c(t)k+s(t)]. R2 values of 89.7, 58.0, 65.3, 77.9, 80.3, 31.1, 30.1, and 26.9 were obtained for TCD, LVSD, LVDD, RVSD, RVDD, LVW, IVSW, and RVW, respectively. Variability analysis indicated a progressive increase in variability with fetal age for these eight parameters. Variability data were used with the growth curve models to determine standard curves for these parameters. These standard curves provide a superior means for evaluating the normal fetal cardiac growth in the fetus and for identifying congenital heart anomalies in utero.

Fetal liver length measurement does not provide a superior means for prediction of a small for gestational age fetus.

To assess the growth of the fetal liver in normal pregnancies and evaluate the ability of fetal liver length measurement for prediction of small for gestational age fetuses, ultrasonographic examinations were performed on 162 normal fetuses, ranging from 15 to 40 weeks menstrual age. The optimal mathematical function and normal range of liver length were generated. The liver length was obtained in 21 small for gestational age fetuses between 34 and 40 weeks, and the ability to use fetal liver length measurement for prediction of small for gestational age fetuses was investigated. A curvilinear relationship was found between the menstrual age and liver length (R2 = 91.9%), and a normal range of liver length measurement for estimating the growth of the fetal liver during normal pregnancy was generated. The liver length was normal in 19 of 21 small for gestational age fetuses (90.5%). The fetal liver length measurement does not provide a superior means for identifying the small for gestational age fetus.