Sturla H. Eik-Nes

Ultrasonographic velocimetry of the fetal ductus venosus

In fetal lambs, the ductus venosus shunts well-oxygenated blood directly to the heart, a pattern expected to be found also in the human fetus. We aimed to describe the human ductus venosus in a longitudinal sonographic study of two-dimensional imaging, colour flow mapping, and pulsed doppler velocimetry every 3-4 weeks during the second half of pregnancy. The fetuses of 29 healthy women were studied. The ductus venosus and its blood flow were identified and recorded for later analysis that included maximum velocity tracing. In the 184 examinations analysed, the ductus venosus appeared as a narrow vessel projecting a high-velocity jet posteriorly to reach the foramen ovale. The mean peak velocity in the ductus venosus increased from 65 cm/s in week 18 to 75 cm/s at term. Low values of the time-averaged maximum velocity were found in 2 fetuses with cardiovascular abnormalities (1 supraventricular tachycardia, 1 congestive heart failure), as a result of reversed flow in the ductus venosus during atrial systole. The high peak velocity in the ductus venosus, which is comparable with arterial velocities, probably gives the blood sufficient momentum to reach the foramen ovale without extensive mixing with deoxygenated blood. Velocimetry of the ductus venosus carries new diagnostic possibilities.

Long-Term Effectiveness Of The Burch Colposuspension In Female Urinary Stress Incontinence

Of 91 women who underwent Burch colposuspension, 86 were available for clinical, urodynamic and isotope renographic follow‐up examinations 5 years after surgery for evaluation of late complications and long‐term effectiveness in urinary stress incontinence. A repeat urodynamic examination was accepted by 76 patients. Stress incontinence was cured in 71 % of the patients with a stable bladder preoperatively, and in 57% with stress incontinence and detrusor instability (non‐significant difference). Cure rate was not significantly related to age, hormonal status or previous anterior vaginal repair. The urodynamic measurements at follow‐up showed a significant increase in the functional urethral length in the cured group, as compared with the improved group. The mean maximum urethral closure pressure was reduced in both groups. Symptomatic detrusor instability was found in 18% of the preoperative stable bladders, while 67% of the unstable bladders had become stable. Only 29% of the patients with a preoperative unstable bladder had a normal lower urinary tract function at follow‐up. Late voiding difficulties were observed in 3% of the study group; enterocele, requiring surgical repair, developed in 7%. One patient suffered a damaged kidney due to undetected ureteral obstruction after surgery. Irritative bladder symptoms such as urgency, frequency, stranguria and nocturia represent a long‐term problem after colposuspension. At the 5‐year follow‐up, only 52% of the study group were completely dry and free of complications, and about 30% needed further incontinence therapy. This may be due to some neurogenic factor which is not corrected by surgery.

Prenatal detection of heart defects in a non‐selected population of 30 149 fetuses—detection rates and outcome

To evaluate the detection rate of congenital heart defects (CHD) in a non‐selected population and to follow outcome after diagnosis.

The examiner's ultrasound experience has a significant impact on the detection rate of congenital heart defects at the second‐trimester fetal examination

To determine whether training and experience in performing ultrasound examinations are factors that influence the prenatal detection of congenital heart defects (CHDs) in a non‐selected population, in order to evaluate and improve the current training program.

Routine ultrasonography in utero and subsequent handedness and neurological development.

OBJECTIVE--To examine any associations between routine ultrasonography in utero and subsequent brain development as indicated by non-right handedness at primary school age and neurological development during childhood. DESIGN--Follow up of 8 and 9 year old children of women who took part in two randomised, controlled trials of routine ultrasonography during pregnancy. SETTING--Clinics of 60 general practitioners in Norway during 1979-81. Maternal and child health centres. SUBJECTS--2161 (89%) of 2428 eligible singletons were followed up, partly through a questionnaire to their parents and partly through information from health centres. MAIN OUTCOME MEASURES--The dominant hand of the child was assessed by 10 questions. Deficits in attention, motor control, and perception were evaluated by five questions. Impaired neurological development during the first year of life was assessed by an abbreviated version of the Denver developmental screening test. RESULTS--The odds of non-right handedness were higher among children who had been screened in utero than among control children (odds ratio 1.32; 95% confidence interval 1.02 to 1.71). No clear differences were found between the groups with regard to deficits in attention, motor control, and perception or neurological development during the first year of life. CONCLUSION--Our data suggest a possible association between routine ultrasonography in utero and subsequent non-right handedness, whereas no association with impaired neurological development was found. As the question on non-right handedness was one of six initial hypotheses, the observed results may be due to chance. None the less, the results suggest that the hypothesis may have some merit and should be tested in future studies.

A cardiovascular profile score in the surveillance of fetal hydrops

Objective. To assess the value of a cardiovascular profile score in the surveillance of fetal hydrops. Methods. In a retrospective study, 102 hydropic fetuses were examined between 15 and 37 completed weeks of gestation with ultrasonographic assessment of hydrops, heart size, and cardiac function, and arterial umbilical and venous Doppler sonography of the ductus venosus (DV) and the umbilical vein (UV). A cardiovascular profile score (CVPS) was constructed by attributing 2 points for normal and taking away 1 or 2 points for abnormal findings in each category. The score of the final examination prior to treatment, delivery, or fetal demise was compared to the fetal outcome in these 102 fetuses after exclusion of terminated pregnancies. The scores of the first and last examinations were compared in 40 fetuses and the relationship between these scores and the evolution of fetal hydrops and fetal outcome was assessed. Results. Twenty-one pregnancies were terminated (21%). Fifty-four of the remaining 81 hydropic fetuses survived (67%) and perinatal death (PNM) occurred in 27 fetuses (33%). The median CVPS was 6.0 (IQR 4.75–8.00) for all fetuses, with a median of 6.0 (IQR 5.00–6.00) in fetuses who died in the perinatal period compared to a median of 7.0 (IQR 4.00–8.00) in those who survived (p < 0.035). All fetuses in this study had a ‘severe’ form of hydrops with skin edema. The best predictor for adverse outcome was the venous Doppler sonography of UV and DV, in particular umbilical venous pulsations. Among fetuses included in the longitudinal arm of the study, the survival rate was 40% and the PNM was 60%, after exclusion of terminated pregnancies. CVPS increased by a median of 1 (IQR 0.00–2.00) point in the last exam for those fetuses that lived, whereas among those fetuses that died, the CVPS decreased by a median 1.5 (IQR 0.25–2.75) points (p < 0.001). Conclusions. The fetal cardiovascular profile score can be used in the surveillance of hydropic fetuses for prediction of the presence of congestive heart failure and as an aid for predicting fetal outcome.

Surveillance and outcome of fetuses with gastroschisis

Infants with gastroschisis have a high survival rate. However, the rate (10–15%) of intrauterine fetal death (IUFD) is considerable, and the association with fetal distress is well known. The aim of this study was to describe the outcome of fetuses with a prenatal diagnosis of gastroschisis. The impact of correct prenatal diagnosis, surveillance and signs of complicating risk factors were evaluated.

Estimation of the pressure gradient across the fetal ductus venosus based on doppler velocimetry

In the fetus, the umbilical vein is directly linked to the inferior vena cava by the narrow ductus venosus. Thus, the ductus venosus blood velocity probably reflects the pressure gradient between the umbilical vein and the central venous system. In a longitudinal study that included 29 normal fetuses, pulsed Doppler velocimetry was carried out in the umbilical vein and the ductus venosus during the last half of the pregnancy. By applying the Bernoulli equation, we estimated the pressure gradient across the ductus venosus to vary between 0-3 mm Hg during the heart cycle; it remained within those ranges during gestational weeks 18-40. During fetal inspiratory movement, pressure gradients up to 22 mm Hg were estimated. The estimated ductus venosus pressure gradient seems to be within ranges compatible with known umbilical venous pressures, and may provide a new opportunity to understand central venous hemodynamics and respiratory force in the fetus once methodological limitations are controlled.

Gestational age in pregnancies conceived after in vitro fertilization: a comparison between age assessed from oocyte retrieval, crown‐rump length and biparietal diameter

Objective  To compare gestational age (GA) and day of delivery estimated from the time of in vitro fertilization (IVF) (oocyte retrieval + 14 days), the ultrasonic measurement of the crown–rump length (CRL) and the biparietal diameter (BPD) in pregnancies conceived in an IVF setting.

Sonoembryology and early prenatal diagnosis of neural anomalies

In the following review, the early development of the central nervous system (CNS), as described by embryologists and anatomists in modern embryological textbooks, is compared with sonoanatomic descriptions from two‐dimensional (2D) and three‐dimensional (3D) ultrasound studies, week by week in the first trimester. The anatomic descriptions are limited to details that are of interest for the understanding of ultrasound examinations. Further, the detection of main CNS anomalies including spina bifida during the first trimester are presented and discussed. Empty or enlarged brain cavities, or abnormal contours of the head and spine are important diagnostic markers for the detection of CNS anomalies in the very early pregnancy. Copyright