Robert Breckle

Ultrasonic evidence for luteinization of unruptured preovulatory follicles

Luteinization of an unruptured ovarian follicle has been reported as a cause of infertility and has heretofore been diagnosed only by direct visualization of the ovarian surface. Four patients who demonstrated defects in ovulation requiring therapy to induce ovulation and who were not achieving desired conception despite apparently adequate treatment were studied with serial pelvic ultrasonic examinations for 17 cycles. Luteinization, characterized by the loss of a clear demarcation of the follicular cyst wall and the presence of intrafollicular echoes, was suspected in each of these cycles by the absence of ultrasonic signs of ovulation--that is, a rapid decrease in follicular size and the appearance of free fluid in the cul-de-sac. Histologic confirmation of a persistent luteinized cyst is presented.

Oligohydramnios: Ultrasonically detected incidence and subsequent fetal outcome

Oligohydramnios is a hallmark for intrauterine growth retardation (IUGR) and has been evaluated in populations suspected of having IUGR. We chose to evaluate its incidence in a routine obstetric population. During a 16-month period, ultrasound scans were performed on 1,408 patients. Severe oligohydramnios was identified in six patients (0.43%); Two infants had congenital malformations, and four had severe IUGR. A subset of 317 patients scanned within 2 weeks of delivery was reviewed. Although none of the patients fulfilled our original criterion of oligohydramnios (absence of a pocket of amniotic fluid 1 cm or more in broadest diameter), three of six small-for-gestational age infants had a subjective decrease in amniotic fluid volume for their stated gestational age. By changing the criterion of oligohydramnios to a subjective decrease in amniotic fluid volume, the sensitivity of this ultrasonic marker was increased to 50% and the specificity to 100%. We believe that the semiquantitative assessment of amniotic fluid volume can effectively screen for IUGR and thereby delineate a population, regardless of gestational age, that is at risk for perinatal morbidity and mortality.

Urinary Tract Anomalies Detected by Prenatal Ultrasound Examination at Mayo Clinic Rochester

OBJECTIVE To determine the frequency of fetal urinary tract anomalies and to characterize the types of such abnormalities detected on ultrasonography and the outcome of affected patients during a 15-year period at our institution. DESIGN We retrospectively reviewed the findings on maternal prenatal ultrasound examinations and the postnatal medical records of 56 children with urinary tract abnormalities detected by prenatal ultrasound examination at Mayo Clinic Rochester from November 1979 to June 1994. RESULTS Of the 56 children, 18 (32%) had severe urinary tract anomalies in conjunction with oligohydramnios, pulmonary hypoplasia, and perinatal death (Potters syndrome). The other 38 infants had various urinary tract abnormalities--most commonly, isolated hydronephrosis and multicystic dysplasia of the kidney. Six of the 38 children had more than one renal abnormality detected prenatally. Reflux was noted in association with prenatally detected urinary tract abnormalities in 4 of 32 newborns (12%) who underwent voiding cystourethrography. In fetuses with normal amniotic fluid volume, the perinatal outcome was good. Children with lower urinary tract obstruction had evidence of more severe renal dysfunction than did those with involvement at more proximal levels. The presence or absence of urinary tract obstruction postnatally could not be determined reliably on the basis of prenatal ultrasound appearance. CONCLUSION In this study, more than half of all prenatally detected urinary tract abnormalities were isolated hydronephrosis or multicystic dysplasia of the kidney. Postnatal renal function could not be reliably predicted on the basis of prenatal ultrasound findings.

Prenatal detection of congenital malformations by ultrasonography: Mayo clinic experience

Routine obstetric ultrasonography has been performed at our institution since 1974. During a recent 41-month period, 64 neonates with 83 congenital abnormalities had been scanned before delivery. The detection rate according to the organ system involved and the year in which the study was performed is reviewed. Suggestions, based upon the data presented, are given for the various anatomic sites and fetal dimensions that should be evaluated during each stage II ultrasound examination.

Fetal renal growth evaluated by prenatal ultrasound examination.

OBJECTIVE To determine reference ranges for normal fetal renal size in a population of pregnant patients at Mayo Clinic Rochester. DESIGN Normal fetal kidneys were prospectively analyzed relative to gestational age and to fetal body weight. MATERIAL AND METHODS In 100 pregnant women, prenatal ultrasound examinations were performed between 18 and 39 weeks of gestation. Fetal renal length and volume were determined by prenatal ultrasonography and compared with gestational age and estimated fetal body weight. Reference ranges as a function of gestational age were obtained for fetal body weight, renal length, renal volume, renal length/ body weight, and renal volume/body weight. Reference ranges as a function of body weight were determined for renal length and renal volume. Polynomial least-squares regression analysis was used to model each of the growth variables (Y) as a function of either gestational age or body weight (X). RESULTS Graphic representation of these relationships are presented. These graphs include the 2.5, 5.0, 95.0, and 97.5 percentiles and the predicted value of Y from the regression equations. Fetal body weight, renal length, and renal volume increased throughout gestation, and the ratio between fetal renal volume and body weight remained constant. CONCLUSION These data about normal fetal renal growth relative to gestational age and fetal body weight should help identify fetal abnormalities in renal size or growth patterns.

Ultrasonic assessment of subsequent unexplained infertility after ovulation induction

Summary. The development of ovarian follicles was studied ultra‐sonographically in 21 cycles in eight infertile patients with the diagnosis of ovulatory dysfunction in whom conception did not occur after the defect had apparently been corrected. Pelvic ultrasound demonstrated three patterns in 20 of the 21 cycles studied: ovarian hyperstimulation in seven cycles; follicular atresia before ovulation in three cycles; persistent unruptured follicular cysts in 10 cycles. Recognition of these patterns has been helpful in modifying therapy in infertile patients.

Value of a postvoid scan during adnexal sonography

The position of the uterus and ovaries can be affected by the degree of bladder filling. A postvoid scan may bring into view ovarian pathologic conditions not previously discerned.