经阴道超声诊断不孕症常见宫腔病变的分析——300例与宫腔镜检查结果的比较

目的:探讨经阴道超声检查不孕症患者常见宫腔内疾病的发生率准确性。方法:分析300例同时接受阴道超声及宫腔镜检查的不孕症患者常见宫腔内病变,比较2种方法的各项指标。结果:所占比例最高的宫腔内病变为子宫内膜息肉,其次为宫腔粘连、宫腔畸形,最低的是子宫内膜结核;对各种常见宫腔内病变的诊断,2种检查方法符合率比较无统计学差异(P0.05)。结论:阴道超声在诊断不孕症患者中最常见的宫腔内病变是子宫内膜息肉、宫腔粘连、宫腔畸形,黏膜下肌瘤、内膜结核较少见;子宫内膜息肉、宫腔粘连中各项指标均高,最有利于开展临床工作;对诊断子宫异常增生、慢性非特异性子宫内膜炎,宫腔镜可以定位取材,明显优于阴道超声。     

Incidence of polycystic ovaries and polycystic ovary syndrome amongst women in Melbourne, Australia

BACKGROUND: The incidence of polycystic ovaries (PCO) in the Australian population is unknown. AIMS: To determine the incidence of PCO in a random population of Melbourne women. METHODS: A retrospective survey of the transvaginal ultrasound of female partners of sterile males was undertaken. RESULTS: Twenty-three percent of subjects had polycystic ovaries on ultrasound criteria, 17% bilateral and 6% unilateral. CONCLUSIONS: The incidence of PCO in Australian women is similar to that of other Caucasian populations.     

Ultrasound Imaging in the Management of Ovulation Stimulation

Summary: The present role of ultrasound imaging in the assessment of ovarian response to gonadotrophin therapy was assessed by comparing a group of patients in whom ultrasound was used to determine suitability of follicles for induction of ovulation with a group in whom ultrasound was not available. Ultrasound provides new and useful information, and may allow a reduction in the incidence of multiple pregnancies.     

Significance of the ultrasound location of placental site in early pregnancy

The placenta was located by routine ultrasound scanning before 24 weeks gestation in 615 consecutive obstetric patients. A 'low lying' placenta was present in 175 (28 per cent) of the total group; the incidence decreasing from 32 per cent at 16 weeks gestation to 18 per cent at 24 weeks. Of 94 women with an initial 'low lying' placenta who were selected for rescanning, only five had a placenta praevia persisting beyond the 34th week. Patients with an early 'low lying' placenta had a significantly higher incidence of small-for-dates babies than those in whom the placenta remained clear of the internal cervical os on ultrasound scanning.     

The impact of leiomyomas on pregnancy

In this retrospective case control investigation, 51 pregnant patients who were diagnosed by ultrasound with uterine myomas were compared to 102 randomly selected control patients to determine if the ultrasound diagnosis of one or more leiomyoma is associated with increased untoward pregnancy outcomes compared to controls. Women with uterine myomas were older (p = 0.001), more likely to be African American (p = 0.001), and undergo Caesarean delivery (p = 0.03) than controls. However, when women who underwent abdominal delivery for previous myomectomy (n = 5) were excluded from analysis, there was no significant difference in the incidence of Caesarean delivery. Overall, there was no difference in the incidence of obstetric complications between groups even when the data was stratified for large and/or multiple leiomyomas. The discovery of uterine leiomyomas by gestational ultrasound does not appear to place the patient at increased risk for preterm labour, early delivery, or other untoward pregnancy outcomes.     

早孕期胎儿鼻骨缺失与染色体异常关系的研究

目的:探讨早孕期胎儿鼻骨缺失与胎儿染色体异常之间的关系。方法:回顾性分析2016年1月至2017年12月广州医科大学附属第三医院产前诊断及胎儿医学中心和福建医科大学附属第一医院超声影像科早孕期超声检查提示胎儿鼻骨缺失的相关资料,分析胎儿单纯鼻骨缺失及其在合并其他超声异常时对诊断染色体异常的价值。结果:高龄孕妇的胎儿单纯鼻骨缺失及合并其他超声异常时胎儿染色体异常的发生率分别为6. 78%和75. 00%,同非高龄孕妇的胎儿染色体异常率(分别为0. 80%和42. 50%)比较,差异均有统计学意义(P <0. 05)。胎儿单纯鼻骨缺失的染色体异常率为2. 72%,当合并其他异常指标时,胎儿染色体异常率升至58. 75%,差异有统计学意义(P <0. 01)。胎儿鼻骨缺失在合并颈项透明层(NT)增厚时,胎儿染色体异常的总发生率为60. 81%。当NT>3. 5 mm时胎儿染色体异常率达77. 78%,与NT≤3. 5 mm时的染色体异常发生率(34. 48%)比较,差异有统计学意义(P <0. 05)。结论:早孕期超声检查提示胎儿鼻骨缺失时,需详细的胎儿超声结构筛查评...     

Renal ultrasound to detect hydronephrosis: a need for routine imaging after radical hysterectomy?

Background

Hydronephrosis can be a side effect of radical hysterectomy for cervical cancer. The incidence of clinically relevant hydronephrosis has not been studied in a large sample and the benefit of early detection of hydronephrosis is not clear.

Objective

To assess the incidence of hydronephrosis, following radical hysterectomy and evaluate the usefulness of routine renal ultrasound (RH).

Methods

Retrospective study, January 1998 and December 2008. Cervical cancer patients (FIGO stage IBI-IIA), treated with radical hysterectomy and pelvic lymph node dissection with or without adjuvant radiotherapy, without surgical lesion of the ureter, followed-up 6 months in the Academic Medical Center Amsterdam. Routine renal ultrasound was performed four weeks after RH, and in some on indication before or after the routine ultrasound. We documented which interventions for hydronephrosis were performed and evaluated the profile of patients at risk for hydronephrosis.

Results

281 patients were included: 252 (90%) underwent routine renal ultrasound and 29 (10%) underwent imaging on indication before routine ultrasound. The overall incidence of hydronephrosis was 12%. In symptomatic patients, the incidence was 21% and 9% in asymptomatic women undergoing routine ultrasound. Four patients were invasively treated for hydronephrosis (1% of the total group) after imaging for clinical suspicion of hydronephrosis. Patients with hydronephrosis were significantly more often treated with radiotherapy than patients without (43% versus 25% (p = 0.03).

Conclusion

There is no place for routine renal ultrasound following radical hysterectomy. Patients should be instructed about the symptoms that may be related to hydronephrosis, to allow for renal ultrasound on indication.     

Perinatal Outcome with Sonographically Thin Placentas

In order to determine the incidence and significance of sonographically thin placentas, we reviewed the computerized records of 18,937 viable, singleton pregnancies. Of these, 0.6% had thin placentas diagnosed by ultrasound examination with a mean thickness of 16 ± 4 mm in the second and 20 ± 3 mm in the third trimester. At the time of the first ultrasound diagnosis of a thin placenta, 22.2% had polyhydramnios, and 1.8% had oligohydramnios. When the thin placenta cohort without polyhydramnios was compared to controls, there was a significantly increased incidence of perinatal mortality, odds ratio = 2.9, 95% confidence limits (CL) = 1.2 to 7.3; neonatal intensive care unit admissions, odds ratio = 2.2, CL = 1.3 to 3.7; and birth weight below the 10th percentile, odds ratio = 2.8, CL = 1.7 to 4.7. The finding of a thin placenta by ultrasound should alert the clinician to the possibility of compromised perinatal outcome.     

Motor and cognitive development of infants with intraventricular hemorrhage, ventriculomegaly, or periventricular parenchymal lesions

Two hundred twenty-six moderate- or high-risk newborn infants were studied to examine the relationship between ultrasound findings in the newborn period and at 6 months and motor and cognitive deficits at 1 year. A three-part classification of abnormal ultrasound findings was used to grade intraventricular hemorrhage, ventriculomegaly, and parenchymal lesions. Abnormal ultrasound findings were observed in 48 infants, of whom 21 had intraventricular hemorrhage, 18 persistent ventriculomegaly, and nine parenchymal lesions. The incidence of deficits was as follows: normal ultrasound examination, 20%; intraventricular hemorrhage, 33%; persistent ventriculomegaly, 67%; and parenchymal lesions, 89%. The present study indicates that serial ultrasound examinations are indicated in preterm newborn infants less than 1500 gm and in selected newborn infants at risk and greater than 1500 gm at birth. The three-part classification of abnormal ultrasound findings should be used because of the predictive significance of persistent ventriculomegaly and parenchymal lesions for motor and cognitive deficits at 1 year of age.     

Trisomies and other chromosome abnormalities detected after positive sonographic findings

OBJECTIVE: To evaluate the rate of trisomies and other chromosome abnormalities after positive ultrasound findings in thefirst and second trimester of pregnancy. STUDY DESIGN: The study investigated chromosome abnormalities detected in cases with prior abnormal ultrasoundfindings. During a 10-year period there were 1907 invasive interventions carried out with the purpose of chromosome analysis. The intervention was genetic amniocentesis in 1619 cases and chorionic villus sampling in 288. RESULTS: Karyotyping revealed 103 cases (5.4%) of chromosome abnormalities. Abnormalities with subcutaneous edema were examined: abnormal karyotype was found in 20% of cases with nonimmune hydrops, 48.1% of cases with cystic hygroma and 53.8% of cases with nonimmune hydrops and cystic hygroma together, 8.3% of cases with nuchal edema in the first trimester and 5.5% in the second trimester. The incidence of chromosome abnormalities in cases of cerebral anomalies was 6.3% of cases with ventricular dilatation, 3.6% of cases with choroid plexus cysts and 15.9% of cases with other cranial anomalies. Regarding abnormalities of the heart, isolated echogenic intracardiac focus and ventricular septal defects were not associated with chromosome abnormality, but, in conjunction with other positive ultrasound findings, the incidence of chromosome abnormalities was 7.9% and 26.7%, respectively. Other anomalies of the heart and large blood vessels showed an abnormal karyotype incidence of 18.2%. In cases of unilateral pyelectasis unassociated with other anomalies, the incidence of chromosome abnormalities was 1%. In cases of bilateral pyelectasis or pyelectasis associated with other anomalies, the incidence was 3%. In terms of anomalies of the abdominal wall and abdomen, the incidence of association with chromosome abnormalities was 9.5% in cases of omphalocele, 11.8% in cases of duodenal atresia and 5.7% in cases of echogenic bowel. In cases of short femur and humerus the rate of abnormal karyotypes was 16%. CONCLUSION: Ultrasound plays an important role in prenatal diagnosis. In cases of positive ultrasound findings, karyotyping is reasonable.     

Effect on Pregnancy on Gallstone Formation

An ultrasound study was carried out to determine the incidence of gallstone formation during pregnancy. One hundred and thirty seven pregnant women attending antenatal clinics were studied; 70 women were primigravidas and 67 were 1 para or more. An ultrasound of the gallbladder was carried out at 20 weeks or less of gestation and a repeat of ultrasound examination was performed soon after delivery. Five women had gallstones diagnosed before pregnancy; 1 of these was a primigravida, the other 4 were para 1 or more. None of the women developed gallstones during pregnancy. This finding suggests that pregnancy is unlikely to be an important factor in gallstone formation.     

Natural history of uterine polyps and leiomyomata

OBJECTIVE: To estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women. METHODS: Saline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding. RESULTS: The mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%, P =.04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted. CONCLUSION: Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic.     

Synchronous intrauterine and ectopic pregnancy associated with clomiphene citrate

Although synchronous intrauterine and ectopic pregnancies associated with the use of clomiphene citrate for infertility are rare, the actual incidence might, in fact, be considerably higher than previously thought. The cornerstone for ruling out an extrauterine gestation is the presence of sonographic evidence of an intrauterine pregnancy, as the possibility of concomitant intrauterine and extrauterine gestation is perceived to be statistically rare. This has resulted in an unacceptably high incidence of negative ultrasound interpretations. During a recent 12 month period, four women treated with clomiphene citrate for infertility were diagnosed as having concomitant intrauterine and ectopic pregnancies. Three had pelvic sonograms that were erroneous for the extrauterine component. However, successful evacuation of the products of ectopic gestation was performed in each, despite an immediate preoperative false-negative ultrasound report. Three of the women delivered healthy normal infants at full term, and the fourth woman spontaneously aborted the products of the concomitant intrauterine gestation. All four did well postoperatively, and no gross complications were encountered. Reassessment of ultrasound diagnostic criteria and the use of more sensitive methods, such as endovaginal ultrasound in high risk patients, are indicated for any symptomatic patient using clomiphene citrate for infertility. Awareness of the prevalence of this entity and the limitations of ultrasound will lead to prompt intervention and improved survival rates.     

Incidence and diagnosis of unilateral arterial cerebral infarction in newborn infants

AIMS: Magnetic resonance imaging (MRI) is accepted as the gold standard for the diagnosis of arterial cerebral infarction (ACI), but few studies have reported the incidence of neonatal ACI based on MRI findings. We provide new population-based epidemiologic and diagnostic data on all infants diagnosed between 1997 and 2002 in our center with an MRI-confirmed diagnosis of unilateral neonatal ACI. RESULTS: Nine patients were identified, giving an incidence of 1:2300 unilateral ACIs in our inborn population. In all patients the middle cerebral artery was affected. Seven patients showed epileptic seizures, usually starting within the first 3 days of life. EEG was pathologic in all patients. Only three infarctions were diagnosed by ultrasound. Initial MRI established diagnosis of ACI in eight out of nine patients and subsequent MRI described the exact location of infarctions in all patients. Six out of nine patients developed hemiparesis and five had deficits in language development. There is a substantial need for special care facilities and long-term therapeutic interventions. CONCLUSIONS: The incidence of neonatal ACI is higher than previously reported. The sensitivity of early cerebral ultrasound for diagnosis of ACI is low. Seizures in the first 3 days of life combined with pathologic EEG findings should lead to MRI, regardless of normal cerebral ultrasound.     

One-stage ultrasound screening in pregnancy. An evaluation

A one-stage ultrasound screening program was evaluated, using a pregnancy/perinatal database containing information from 2766 pregnancies and deliveries. Among women who did not have a second-trimester ultrasound examination, labor was induced for presumed post-term pregnancy in 4.0% versus 1.6% of pregnancies in the screening group (p = 0.007). In the group with second-trimester ultrasound scanning other than screening, the frequency was 3.2%. Of women with spontaneous labor or who were induced for presumed post-term pregnancy, 3.8% in a screening group and 8.0% in a group with other second-trimester ultrasound examination were post-term according to BPD measurements (p = 0.0003). In the screening group, 6.2% of liveborn singletons were small for gestational age (less than the 10th percentile) compared with 8.5% in the non-screening group (p less than 0.05). A subset of 365 screened women with optimal menstrual history had spontaneous labor or were induced for presumed post-term pregnancy. According to menstrual history and ultrasound examination, 7.4% and 3.8% of these were post-term, respectively (p = 0.04). It is concluded that the main value of screening lies in a more accurate dating of pregnancy, even when menstrual history is optimal, with a lower incidence of induced labor for believed post-term pregnancies. In addition, there may be an improvement in the obstetric management of pregnancy, reflected in our study as a lower incidence of small for gestational age infants.     

Amniocentesis: a Comparison of ''Monitored'' versus ''Blind'' Needle Insertion Technique

The incidence of complications following 382 'blind' amniocenteses, in which ultrasound was used prior to but not during the procedures, was compared with those following 482 'continuously monitored' amniocenteses. The monitored technique was associated with a reduction in the incidence of blood-stained amniotic fluid, the number of attempts required to obtain fluid and with a fall in the number of spontaneous abortions from 9 (2.4%) to 4 (0.8%).     

Clinical and laboratory evaluation of hospitalized patients with severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an important complication of ovarian stimulation and IVF that enhances patients' morbidity. To evaluate any increased incidence of hospitalization from severe OHSS during 2000, this study analysed certain clinical, ultrasound and laboratory characteristics of hospitalized patients with severe OHSS. These studies were carried out on women undergoing IVF who were hospitalized because of severe OHSS between 1996 and 2000 at the H?pital Antoine Béclère. Patients' ages and serum hormone concentrations were collected on day 3 of ovarian stimulation for various assays, and laboratory and ultrasound measurements taken during ovarian stimulation for IVF were compared. An increase was noted during last year in the frequency of the severe form of OHSS requiring hospitalization (0.9 versus 1.8%, P < 0.05). Patients' ages and hormonal characteristics on day 3 of menstrual cycle, and laboratory and ultrasound variables were similar between the two groups. In addition, the increased incidence of OHSS during 2000 was not associated with any special laboratory or ultrasound parameter, and the policy of ovarian induction had not changed. It is essential to introduce a simple ovarian stimulation protocol providing acceptable IVF results with a minimum of risk.     

Midtrimester genetic amniocentesis. Use of ultrasound direction vs. blind needle insertion

A prospective comparison of ultrasound-directed second-trimester genetic amniocentesis to blind amniocentesis showed a significant reduction in the incidence of both bloody taps and failed amniocentesis. The incidence of other parameters, such as fetal outcome, failed culture of amniotic fluid fibroblasts and spontaneous abortion, was similar. These data support the use of amniocentesis under ultrasound control as a routine component of prenatal genetic diagnosis.     

Ultrasonographic diagnosis of asymptomatic cholelithiasis in pregnancy

Using a static B scanner, 203 pregnant patients underwent cholecystosonography at the time of a routine 24-week ultrasound study. The incidence of asymptomatic cholelithiasis, 2.5%, was less than that reported by others. This low incidence and the increased time needed for cholecystosonography suggest that studies should be done on symptomatic patients only.     

Combined pregnancy: how common is it?

Three cases of combined intrauterine and ectopic pregnancy, treated in the same hospital over a 39-day period, are presented. This condition has been acknowledged to be a rare phenomenon with delayed diagnosis and treatment. Two of the cases were diagnosed by ultrasound upon arrival at the hospital, and all three were treated within 24 h of arrival. These cases highlight the importance of ultrasound in diagnostics and indicate a possible higher incidence of this phenomenon than was previously estimated.