Josef Deutinger

Vaginosonography for recording of cycle-related myometrial contractions.

It has been recognized from experimental or invasive studies that the nonpregnant human uterus has an inherent contractibility. We used vaginosonography for imaging contractions of the inner third of the myometrium. The direction, frequency, and symmetry of contractions were noted. We studied 53 women and subdivided them into four groups based on the cycle phase. During menstruation we found contractions toward the cervix with irregular frequency varying between 1 and 3/min. In the periovulatory period we noted the highest frequency of 10/min of regular contractions toward the fundus. The results showed that active myometrial contractions can be detected sonographically throughout the whole menstrual cycle. Increased myometrial contractions toward the fundus in the periovulatory period may be involved in sperm transport to the tubes.

Transvaginal pulsed Doppler measurement of blood flow velocity in the ovarian arteries during cycle stimulation and after follicle puncture

In experimental studies, an increase of the ovarian blood flow was found during cycle stimulation. In this study, the authors performed transvaginal pulsed Doppler measurements of the ovarian arteries in stimulated cycles before and after follicle puncture. Four days before follicle puncture, high flow velocities in systolis were found compared with diastolis. Toward the day of embryo transfer, a marked increase of the diastolic blood flow velocity was observed. In patients with high endocrine response, the pulsatility index (PI) was significantly lower compared with that of patients with low endocrine response. The technique of transvaginal pulsed Doppler measurements offers the possibility to study the alterations of the ovarian blood flow under physiologic and pathophysiologic conditions.

Endometrial volume change during spontaneous menstrual cycles : volumetry by transvaginal three-dimensional ultrasound

OBJECTIVE At present, only limited data are available on endometrial volume during the menstrual cycle. Most of these studies deal with animal models and use magnetic resonance imaging for volume measuring. The application of three-dimensional ultrasound in endometrial volume estimation is the subject of this study. SETTING Patients visiting the outpatient unit of the division of endocrinology and reproductive medicine of a university hospital. PATIENT(S) Twenty patients with a history of a normal menstrual cycle were selected. INTERVENTION(S) Ultrasound examinations were performed during a single menstrual cycle in addition to routine laboratory tests. MAIN OUTCOME MEASURE(S) Uterus-endometrial volume ratio. RESULT(S) Data from 18 patients could be evaluated. In 81 examinations the endometrium volume could be determined. Mean endometrial volume measured by three-dimensional ultrasound was 1.23 cm3. Mean uterus volume was 48.93 cm3. The change of the uterus-endometrial volume ratio showed a good correlation with the day of menstrual cycle. Quadratic regression analysis of volume and cycle length was R2 = 0.432. CONCLUSION(S) Three-dimensional ultrasound allows assessment of volume data of the female internal genitalia. In this study changes of the endometrial volume in menstrual cycles were measured. Additional studies are required to give information on the clinical impact of this new technique of endometrial volume estimation.

Fetal kidney volume and urine production in cases of fetal growth retardation

The amount of amniotic fluid has a close correlation to the function of the fetal renal system. In many cases of fetal growth retardation oligohydramnios is obvious. The aim of this study is the investigation of the hourly fetal urine production rate (HFUPR) and the growth of fetal kidneys during pregnancy in cases of fetal growth retardation and to evaluate the renal participation in the origin of oligohydramnios in cases of growth retardation. In 52 healthy pregnancies and 27 cases with known fetal growth retardation, the volume of the fetal kidneys was measured sonographically and the hourly rate of fetal urine production was determined. Two third of the patients with fetal growth retardation had obvious oligohydramnios. In cases of fetal growth retardation the volume of the fetal kidneys was significantly smaller when compared to the control group, and the volume of fetal urine production was significantly lower. The reduced perfusion of the fetal kidneys in those cases with fetal growth retardation may be the reason for the reduction of the HFUPR. Due to the fact that HFUPR is a dynamical parameter and in close relationship to the perfusion of the fetal kidneys, the identification and measurement of this parameter may help to detect subacute and imminent fetal distress in cases of sonographically proven fetal growth retardation.

Association of deletions of the chromosomal region 15q24-ter and diaphragmatic hernia: A new case and discussion of the literature

Objective: To provide new insights into how chromosomal aberrations affect fetal development, as well as for the counseling of parents in comparable situations, it is important to characterize and report the genotypes of fetuses with clinical anomalies. Methods: Molecular cytogenetic analyses in a fetus with congenital diaphragmatic hernia (CDH). Results: This report describes the first case of a deletion of the region q26.1-ter on chromosome 15 occurring as a de novo event associated with CDH. A detailed review of the literature provides further evidence of a functional association between deletions within the chromosomal region 15q24-ter and the development of CDH. Conclusions: The obtained data argue that detection of such a deletion in the region 15q24-ter associated with CDH likely predicts a poor prognosis. This report highlights the importance of giving special diagnostic attention to the chromosomal region 15q24-ter when prenatal ultrasound examination provides evidence of a CDH and warrants further research to identify genetic elements within the chromosomal region 15q24-ter related to the development of diaphragmatic hernia.

The influence of the experience of the investigator on the rate of sonographic diagnosis of fetal malformations in Vienna

The quality of prenatal ultrasound may be influenced by different factors. In this study, the influence of the experience of the investigator on the quality of routine ultrasound screening during pregnancy was evaluated. We related the detection rate of fetal malformations in routine ultrasound screening in the region of Vienna to the experience level of the examiner. All 323 cases of fetal malformations registered by the obstetrical departments of Vienna or registered by the Vienna perinatal mortality statistics of 1990 and 1991 were evaluated. For analysis we used the medical charts or the patient‐held antenatal records (‘Mutter‐Kind‐Paß’). Obstetricians in private offices (level I) detected 22 per cent, the examiner in the hospital (level I–II) 40 per cent, and the examiner in the centre for prenatal diagnosis and therapy (level III) 90 per cent of all fetal malformations. The detection rate before the 24th week of gestation was significantly different (25 per cent vs. 34 per cent vs. 58 per cent). Our results suggest that an important factor for the quality of prenatal ultrasound investigation is the education of the sonographers. Furthermore, each pregnant woman should undergo ultrasound screening once in a level II or III centre before 24 weeks or before fetal viability.

Relationship between the steroid and prolactin concentration in follicular fluid and the maturation and fertilizaton of human oocytes

Seventyeight follicles and their follicular fluid were aspirated from 46 women undergoing in vitro fertilization (IVF) procedures after stimulation of the ovaries with a low-dose human menopausal gonadotropin/human chorionic gonadotropin stimulation regimen. The concentrations of estradiol (E2), progesterone (P), testosterone (T), and prolactin (PRL) were measured in follicular fluid and related to the maturation of the oocyte-corona-cumulus complex (OCCC) and the fertilization of oocytes. Follicles containing mature oocytes had significantly higher follicular fluid E2 and P levels than follicles with intermediate and immature oocytes. A constant decrease in PRL and T values with advancing follicular maturation was observed. Similar results were obtained when the fertilizing ability of the oocytes was examined. The gradual decline in follicular fluid PRL and T levels during follicular development was connected with increasing E2 and P biosynthesis and therefore seems to be an important precondition for normal follicular and oocyte maturation.

Fetal and early postnatal magnetic resonance imaging – is there a difference?

Abstract Aim: To evaluate whether fetal magnetic resonance imaging (MRI) could replace early postnatal MRI in fetuses with central nervous system (CNS) anomalies. Methods: Thirteen pregnancies presenting with fetal CNS anomalies were investigated using MRI. Indications included ventriculomegaly combined with additional CNS anomaly (n=5), isolated ventriculomegaly (n=2), arachnoid cyst (n=2), holoprosencephaly (n=1), complex malformation syndrome (ns1), Dandy walker malformation (n=1) and midline cyst (n=1). Early postnatal MRI followed within the first six weeks of life. Results: Investigation with early postnatal MRI confirmed the fetal MRI diagnosis in all cases. Investigation with postnatal MRI presented additional information in two cases. However, there was no change in patient care. Conclusions: Fetal MRI should replace early postnatal MRI in infants with CNS anomalies.

Cystic adenomatoid malformation of the lung : Prenatal diagnosis, prognostic factors and fetal outcome

Aim: To evaluate 14 cases of cystic adenomatoid malformation (CAM) of the lung with regard to antenatal management and fetal outcome. Results: Intrauterine shunts were placed in 3 fetuses to avoid pulmonary hypoplasia. Prenatal sonography showed that the lesions had a tendency to resolve in 4 cases. Of the 9 infants who survived, 5 were treated surgically (lobectomy). Conclusions: The antenatal evolution of these lesions is highly variable; the lesions may even resolve spontaneously, therefore the diagnosis of CAM types II and III should be followed by a period of observation. Intrauterine drainage is recommended in cases of CAM type I if unfavorable prognostic factors are encountered.

Follicular aspiration for in vitro fertilization: sonographically guided transvaginal versus laparoscopic approach

Laparoscopy is the most commonly used procedure for oocyte retrieval in an in-vitro fertilization (IVF) program. In this study we compared the results of 21 laparoscopic and 21 sonographically guided transvaginal oocyte retrievals using a vaginal probe. Laparoscopically 3.7 and transvaginally 4.8 oocytes per patient were recovered. Overall 6 pregnancies were achieved, giving a pregnancy rate of 14.1% per patient. Vaginal follicular aspiration resulted in a higher oocyte recovery rate. The advantages of the method were a shorter operation time, a superficial anesthesia and, compared to laparoscopy, a less invasive and simpler technique. Therefore this method is now commonly used for routine IVF procedures in our institution.