George Kossoff

Umbilical venous flow in normal and complicated pregnancy.

Using pulsed Doppler and B-mode ultrasonic techniques, umbilical venous flow has been measured for the first time under essentially normal physiological conditions. In normal pregnancies, the flow per unit fetal weight remains essentially constant at 110-120 ml/min/kg for most of the pregnancy. In pregnancies with complications, however, abnormally low or high flow values are frequently observed. Low flow values correlate strongly with retarded fetal growth, and with increased incidences of antenatal hypoxia, neonatal morbidity and neonatal death. In some circumstances high flow values suggest the presence of a compensatory mechanism. The results reported here suggest that umbilical flow can be used to separate all fetuses, whether growth retarded or not, into low risk and high risk groups with better sensitivity and accuracy than existing methods. In addition, low flow values have been measured an average of one week before growth retardation or fetal hypoxia were indicated by the conventional methods. A possible strategy for the diagnostic use of umbilical flow measurements is outlined.

Heating of guinea-pig fetal brain during exposure to pulsed ultrasound

Ultrasound-induced temperature elevations in fresh and formalin-fixed fetal guinea-pig brains were measured during in vitro insonation, with a stationary beam in a tank containing water at 38 degrees C. The pulsing regimen used 6.25 microseconds pulses, repeated at a frequency of 4 kHz emitted from a focussed transducer operating with a centre frequency of 3.2 MHz. The greatest temperature rise in brain tissue occurred close to bone and correlated with both gestational age and progression in bone development. After a 2 min insonation with a spatial peak temporal average intensity (ISPTA) of 2.9 W/cm2, a mean temperature elevation of 5.2 degrees C was recorded in fetuses of 60 days gestation (dg). The same exposure produced an increase of 2.6 degrees C in the centre of whole brains of 60 dg fetuses when the bony cranium was removed. As most of the heating occurs within 40 s, these findings have implications for the safety of pulsed Doppler examinations where dwell-time may be an important factor.

Thickness of tissues intervening between the transducer and fetus and models for fetal exposure calculations in transvaginal sonography

In transvaginal scanning the tissues intervening between the fetus and transducer are relatively thin. The average thickness in the first trimester is 25 mm and reduces to 15 mm by the third trimester; the minimum thicknesses are 14 and 8 mm, respectively. Two models are proposed for calculating exposure in transvaginal scanning. The models are considered in terms of the overlying tissues and the target tissues. A fixed path, constant attenuation of 0.3 dB/MHz describes the properties of the overlying tissues throughout pregnancy. In the model used in first-trimester scanning, the target tissues of the embryo/fetus are considered to have properties similar to those of soft tissues, and they attenuate the energy at the same rate as the overlying tissues. In the model used in second- and third-trimester scanning, the bony structures of the fetus are the target tissues. These reflect 30% of the incident energy and attenuate all of the transmitted energy at their surface.