המרכז הירושלמי לעל קול וארבע מימד

Congenital fibrosarcoma is a rare soft tissue sarcoma. A 22-year-old woman in the 22nd week of her first pregnancy underwent sonographic examination, which revealed a soft tissue swelling of the fetus's left thigh. The pregnancy was terminated, and congenital fibrosarcoma was diagnosed by pathologic examination. To our knowledge, this is the first published report of the intrauterine sonographic observation of this tumor in a fetal extremity.

למאמר המלא לחץ כאן!

# Tadmor OP, Rabinowitz R, Diamant YZ.

Ultrasonic demonstration of local myometrial thickening in early intrauterine pregnancy.

Ultrasound Obstet Gynecol. 1995 Jan;5(1):44-6.

In a group of women in the first and early second trimesters of pregnancy, local thickening of a limited region of the myometrium was observed ultrasonically. This prospective study aimed to evaluate the incidence and nature of this phenomenon. Local myometrial thickening was observed in 72 women out of 5521 examined (1.3%). Twenty-two were given ritodrine hydrochloride 10 mg by mouth, and 46 were monitored for up to 60 min without treatment. The local myometrial thickening in the ritodrine hydrochloride-treated group disappeared in 21 out of 22 women (95.5%) compared with the observed group, where the phenomenon disappeared in only 37 women (80.4%). Local myometrial thickenings probably represent transient uterine contractions; they tend to appear early in pregnancy, are prolonged, and may respond to ritodrine hydrochloride.

למאמר המלא לחץ כאן !

# Shen O, Tadmor OP, Yagel S.

Prenatal diagnosis of persistent right umbilical vein.

Ultrasound Obstet Gynecol. 1996 Jul;8(1):31-3. Review.

A persistent right umbilical vein is thought to be a rare anomaly, frequently associated with other life-threatening malformations. Eight cases of prenatal diagnosis of persistent right umbilical vein are presented. All cases were discovered on a routine second-trimester sonogram in an unselected population. Of the seven babies who were delivered, one had a dextrocardia and right-sided descending aorta, but none had other associated major malformations. The outcome was favorable in all cases and all seven infants are well and thriving with up to a year and a half of follow-up. Our findings suggest that persistent right umbilical vein might not be as rare as the paucity of reports in the literature implies. Provided that no other malformations are present, this anomaly is probably of little prognostic significance, requiring no further evaluation or follow-up.

למאמר המלא לחץ כאן !

#Tadmor OP, Kreisberg GA, Achiron R, Porat S, Yagel S.

Limb amputation in amniotic band syndrome: serial ultrasonographic and Doppler observations.

Ultrasound Obstet Gynecol. 1997 Nov;10(5):312-5.

A 28-year-old woman, gravida 7, para 6, was referred at 21 weeks' gestation to our ultrasound unit because of bilateral fetal lower limb edema diagnosed previously. Ultrasonography showed a constriction ring around both legs, and, with the aid of color Doppler, arterial flow was demonstrated in both legs beneath the constriction ring. Subsequent examinations during the 24th and 28th weeks revealed absence of flow below the constriction ring of the right leg and decreased flow in the left leg. This was followed by the gradual bending, breaking and resorption of the tibia and fibula of the right leg. Between weeks 30 and 34, gradual shrinkage of the remains of the right leg beneath the knee was recorded by serial ultrasonic observations. At the 38th week of gestation, a male infant was born by normal vaginal delivery. Examination at birth revealed amputation of the right leg below the knee, with a denuded end of the stump. There was a partial amputation of the left leg below the knee, with tissue continuity being maintained by the posterior neurovascular bundle, and a posterior strip of skin. The left foot was extremely edematous, with an area of necrosis dorsally. This case afforded us the opportunity of in utero following of natural limb amputation in the amniotic band syndrome.

למאמר המלא לחץ כאן!

#Tadmor O, Bocker Y, Rabinowitz R, Aboulafia Y, Yagel S, Stark M, Diamant YZ, Nitzan M.

Analysis of umbilical artery flow parameters during fetal variable decelerations using computerized Doppler waveforms.

Fetal Diagn Ther. 1999 Jan-Feb;14(1):2-10.

Umbilical artery velocity waves were obtained by Doppler ultrasonography before, during, and after 20 episodes of fetal heart rate (FHR) variable decelerations (VD) during the active stage of labor in 8 women. During 50% of the VD periods, the umbilical artery resistance flow parameters increased significantly (p < 0.01). The increase in resistance preceded the decrease in FHR in six episodes (30%) of VD (AR-VD group; arterial resistance VD) and did not precede the change in FHR in another ten episodes (50%) of VD (VR-VD group; venous resistance VD). In the AR-VD group the FHR accelerations occurred before the decelerations in only 1 case (17%), while in the VR-VD group FHR accelerations preceded the decelerations in 8 out of the 10 episodes (80%). Using these Doppler studies, it may be possible to differentiate between two groups of VD: AR-VD - which are caused by umbilical artery occlusion and thus preceded by a measurable increase in umbilical artery resistance - and VR-VD - which are not preceded by a measurable increase in umbilical artery resistance and may be caused by fetal hypoxia.

# Yagel S, Anteby EY, Rosen L, Yaffe E, Rabinowitz R, Tadmor O.

Assessment of first-trimester nuchal translucency by daily reference intervals.

Ultrasound Obstet Gynecol. 1998 Apr;11(4):262-5.

increased fetal nuchal translucency measured in the first trimester is associated with an elevated frequency of chromosomal abnormalities, yet no reference intervals for transvaginal sonographic measurements of fetal nuchal translucency in that period of development have been established. The aim of the present cross-sectional study was to construct appropriate gestational age-specific reference intervals for nuchal translucency. Transvaginal ultrasound was used in 180 normal pregnant women between 9 and 14 weeks of gestation. Reference intervals were constructed by the parametric method. These reference intervals were then compared to the traditional threshold value of 3 mm, when applied to 287 women scheduled for amniocentesis or chorionic villus sampling (CVS). Both methods had the same sensitivity, 85.7%, and negative predictive value, 99.6%, in predicting fetal chromosomal abnormalities. However, the specificity of the gestational age-related reference intervals tended to be higher than that of the 3-mm threshold: 94.6% vs. 87.9%. The positive predictive value of the former method was higher than that of the 3-mm threshold: 28.6% vs. 15%. The increased specificity and positive predictive value of these reference intervals are of particular importance when applied to women under the age of 35 years. In those women, the finding of an abnormally thick nuchal translucency can lead to the performance of amniocentesis or CVS. Therefore, using these reference intervals instead of the traditional 3-mm threshold may save a significant number of unnecessary invasive procedures.

#Zlotogorski Z, Tadmor O, Rabinovitz R, Diamant Y.

Parental attitudes toward obstetric ultrasound examination.

J Obstet Gynaecol Res. 1997 Feb;23(1):25-8.

OBJECTIVE: The aim of the study was to assess the effect of ultrasound examination on parental attitudes and anxieties. MATERIAL AND METHOD: Ultrasound examinations were carried out on 1,089 pregnant women with uncomplicated pregnancies at a mean gestational age of 20.9 weeks (minimum 10 weeks). Before and after the ultrasound examination, patients completed a questionnaire comprising 26 five-point numerical scales relating to anxiety levels, and difference scores for pre- and post-scan levels of fears and anxieties were computed. RESULTS: We showed that the reduction of anxiety following ultrasound examination was inversely related to gestational age, but was unrelated to demographic or medical variables, such as the risk level at the time of the scan. Similarly, anxiety was not reduced because of the presence of the spouse, although the spouse's presence did significantly increase inter-partner bonding. CONCLUSION: This study showed that "routine" ultrasound scan may have significant psychological effects on parental attitudes toward each other and the fetus.

# Zlotogorski Z, Tadmor O, Duniec E, Rabinowitz R, Diamant Y.

The effect of the amount of feedback on anxiety levels during ultrasound scanning.

J Clin Ultrasound. 1996 Jan;24(1):21-4.

This study examined the influence of different levels of feedback and of other situational and buffering variables on the psychological effects of ultrasound examinations of 211 pregnant women. The patients were randomly assigned to two different experimental conditions: high feedback and low feedback. The subjects' levels of anxiety (both trait- and state-anxiety) were measured immediately before and after the ultrasound examination. Overall, there was a significant decrease in the level of state-anxiety, which could not be explained by the different levels of feedback provided. Situational and buffering variables were not found to be related to the degree of psychological benefit produced by the scan.

# Zlotogorski Z, Tadmor O, Duniec E, Rabinowitz R, Diamant Y.

Anxiety levels of pregnant women during ultrasound examination: coping styles, amount of feedback and learned resourcefulness.

Ultrasound Obstet Gynecol. 1995 Dec;6(6):425-9.

Anxiety levels were measured before and after ultrasound examination in 183 women who underwent the procedure as part of their routine prenatal care. Women were classified according to their preferred mode of information gathering, their amount of available cognitive resources and predetermined feedback conditions. The results indicated significant reductions in state or situational anxiety levels for all subjects while trait anxiety was unaffected. In addition, the results suggested a correspondence between learned resourcefulness and informational coping styles. Women who had higher levels of cognitive resources and actively sought out information showed significantly greater decreases in state anxiety levels. This finding was also true for women who had lower levels of cognitive resources and tended to block out information. The impact of the scan was more profoundly affected by personality repertoires and informational coping styles than by either of the feedback conditions.

#Landau D, Seelenfreund MH, Tadmor O, Silverstone BZ, Diamant Y.

The effect of normal childbirth on eyes with abnormalities predisposing to rhegmatogenous retinal detachment.

Graefes Arch Clin Exp Ophthalmol. 1995 Sep;233(9):598-600.

Pregnant women who have high myopia, a history of retinal detachment or retinal holes, or have known lattice degeneration are frequently referred to an ophthalmologist for advice concerning the management of pregnancy and labor, i.e. whether a spontaneous vaginal delivery can be allowed and whether prophylaxis for high-risk retinal pathology is indicated. Many obstetricians still believe that pregnant women with ocular abnormalities predisposing to rhegmatogenous retinal detachment should have an instrumental delivery, and a few even advocate cesarian section. Very little has been written about the management of pregnant women with high-risk retinal pathology, and opinions differ considerably. Patient data on this subject are scarce. METHODS: We studied 10 women who had 19 deliveries (10 prospective and 9 retrospective) and who had a history of retinal detachment, had been diagnosed as having extensive lattice degeneration, or had been treated for symptomatic retinal holes or breaks. The women were followed from the third trimester of pregnancy through labor and delivery into the postpartum period, looking for changes in the retinal status. RESULTS: We found no changes in the retinal status in the postpartum examination. CONCLUSION: We conclude that prenatal treatment of asymptomatic retinal pathology is not indicated and that spontaneous vaginal delivery may be allowed to take place in women with high-risk retinal pathology.

# Tadmor O, Nitzan M, Rabinowitz R, Skomorovsky Y, Aboulafia Y, Diamant YZ.

Prediction of second trimester intrauterine growth retardation and fetal death in a discordant twin by first trimester measurements. Case report and review of the literature.

Fetal Diagn Ther. 1995 Jan-Feb;10(1):17-21. Review.

Ultrasound examination at 9 weeks of gestation in a 34-year-old primigravida showed a twin pregnancy, with discrepancy in the sizes of the two gestational sacs, whereas the crown-rump lengths and fetal heart rates were virtually identical-the result being an abnormal sac size/crown-rump length ratio (early oligohydramnios). By 14 weeks discordant heart rates and umbilical artery flow velocities were detected, the discordance between the twins increasing as pregnancy progressed. Biparietal diameters, femoral lengths, and abdominal circumferences were also progressively discordant, and at 28 weeks the smaller twin had no heart beat. At 30 weeks the patient was delivered of a live 1,350-gram infant and a 400-gram dead fetus. This case suggests, in contradistinction to several previous reports, that fetal discordance in twin pregnancies (and perhaps intrauterine growth retardation in general) may be present as early as the first trimester

#Tadmor O, Nitzan M, Rabinowitz R, Chizhevsky A, Skomorovsky Y, Aboulafia Y, Anteby E, Diamant YZ, Yagel S.

Continuous determination of umbilical artery flow parameters during fetal bradycardia using computerized analysis of Doppler wave forms.

Fetal Diagn Ther. 1994 May-Jun;9(3):186-95.

Umbilical artery flow curves were obtained by Doppler ultrasonography before, during, and after episodes of fetal bradycardia in the active stage of labor in 6 women. Between 126 and 1,607 Doppler wave forms were analyzed for each patient. During the periods of bradycardia all the umbilical artery resistance flow parameters increased (p < 0.00001). The increase in resistance did not precede the change in heart rate. This study presents an accurate and reproducible method for continuous evaluation of the changes in the impedance of fetal blood flow during fetal heart rate changes, thereby enabling detailed assessment of circulatory disturbances occurring during labor and delivery.

#Anteby EY, Tadmor O, Revel A, Yagel S.

Post-term pregnancies with normal cardiotocographs and amniotic fluid columns: the role of Doppler evaluation in predicting perinatal outcome.

Eur J Obstet Gynecol Reprod Biol. 1994 Apr;54(2):93-8.

OBJECTIVE. To study the role of Doppler ultrasound examination in predicting an abnormal perinatal outcome, among post-term pregnancies uncomplicated by an abnormal non-stress test (NST) or reduced amount of amniotic fluid. DESIGN. A prospective study. SETTING. High-risk pregnancy unit, Hadassah Mt. Scopus University Hospital, Jerusalem. SUBJECTS. Seventy-eight women with confirmed gestational age of > 287 days, who had normal initial evaluation and unfavourable cervical examination. INTERVENTIONS. Doppler flow velocity waveforms were recorded from the umbilical and middle cerebral arteries, and from the descending thoracic aorta. MAIN OUTCOME MEASURES. Correlation between Doppler measurements and data regarding delivery. RESULTS. Women who developed signs of fetal distress during labour, or who required intervention because of fetal distress, had elevated umbilical artery systolic/diastolic ratio, decreased middle cerebral artery pulsatility index, and decreased time average aortic blood flow velocity. Umbilical artery Doppler measurements could significantly predict the need for intervention due to fetal distress. CONCLUSIONS. Doppler examination of uncomplicated post-term pregnancies may identify patients with normal results as having a low risk of developing fetal distress during labour. Patients with abnormal Doppler results are prone to need intervention following fetal distress in labour.

#Anteby E, Revel A, Ben-Chetrit A, Rosen B, Tadmor O, Yagel S.

Intrauterine device failure: relation to its location within the uterine cavity.

Obstet Gynecol. 1993 Jan;81(1):112-4.

OBJECTIVE: To investigate the possible role of position of the intrauterine device (IUD) in accidental pregnancies. METHODS: We examined the location of the IUD in 97 normal women 45-60 days post-insertion, and in 25 pregnant women with the device in situ. RESULTS: A cervically located IUD was identified in seven of 97 women (7.2%) after insertion and in 13 of 25 pregnant women (52%) with the device in situ. The odds ratio for a woman with an intracervical IUD to be pregnant compared with a woman with an IUD in the uterus was 13.93 (95% confidence limits 4.13-48.96). Sonographic follow-up of the pregnant women revealed no change in IUD location during early gestation. CONCLUSIONS: We suggest that cases of failed contraceptive action of the IUD may be secondary to a malpositioned device. A sonographic survey can identify displaced devices. Reinsertion of the IUD in such cases is recommended.

# Achiron R, Tadmor O, Kamar R, Aboulafia Y, Diamant Y.

Prerupture ultrasound diagnosis of interstitial and rudimentary uterine horn pregnancy in the second trimester. A report of two cases.

J Reprod Med. 1992 Jan;37(1):89-92.

Pregnancies in an interstitial and rudimentary uterine horn are rare and often fatal varieties of ectopic gestation. Ruptures tend to occur in the second trimester, resulting in maternal morbidity and mortality. Only a few cases of the ultrasonographic diagnosis of unruptured second-trimester interstitial and rudimentary uterine horn pregnancy have been reported. In two such cases second-trimester ultrasonographic examination revealed an unusual pregnancy location, thin uterine wall, incomplete myometrial layer and empty uterus

#Achiron R, Tadmor O, Mashiach S.

Heart rate as a predictor of first-trimester spontaneous abortion after ultrasound-proven viability.

Obstet Gynecol. 1991 Sep;78(3 Pt 1):330-4.

To discover whether first-trimester spontaneous abortion can be predicted by embryonic heart rate (EHR), we performed a cross-sectional study during the first trimester of pregnancy using high-frequency transvaginal sonography combined with pulsed Doppler. Heart rate was measured in 603 embryos; of these, 580 continued beyond 13 weeks' gestation and 23 ended in first-trimester spontaneous abortion. Based on the continuing pregnancies, we constructed and compared EHR nomograms relating to gestational age, mean diameter of the gestational sac, and crown-rump length (CRL). Embryonic heart rate correlated best with CRL (r = 0.87), and the correlation was best described by a second-degree polynomial regression equation. The mean EHR increased progressively from 110 beats per minute (bpm) at CRL of 3-4 mm to 171-178 bpm at CRL 15-32 mm. At CRL greater than 32 mm, the EHR remained stable at a mean of 170 bpm. The EHRs of the 23 embryos that spontaneously aborted in the first trimester were evaluated according to these nomograms. In 15 cases, the EHR fell outside the 95% confidence interval for CRL (sensitivity 65%), but it was within normal limits in eight (false-negative rate 35%). In ten embryos for which pregnancy continued beyond 13 weeks, the EHR fell outside the 95% confidence interval (specificity 98%, false-positive rate 2%). Our findings suggest that EHR measurements in early pregnancy may be useful in the prediction of first-trimester spontaneous abortion after ultrasound-proven viability.

#Achiron R, Tadmor O.

Screening for fetal anomalies during the first trimester of pregnancy: transvaginal versus transabdominal sonography.

Ultrasound Obstet Gynecol. 1991 May 1;1(3):186-91.

Ultrasound is a sensitive tool for the diagnosis of fetal anomalies during the prenatal period. Most knowledge about the ultrasound images of such anomalies is based on abdominal scanning during the second trimester of pregnancy. The value of transvaginal sonography for evaluating fetal anomalies and a comparison with transabdominal sonography in the first trimester has, to our knowledge, so far not been studied.During a 12-month period, 800 pregnant women between 9 and 13 weeks of gestation, underwent first a transabdominal scan followed by a transvaginal examination, in order to compare the value of the two techniques. Eight cases of fetal abnormality, including anencephaly, exencephaly, cervical myelomeningocele, cystic hygroma, omphalocele, posterior fossa cyst and syndactyly, were diagnosed by using the transvaginal sonographic approach. The standard abdominal technique failed to detect four of these anomalies, while in the other four only vague and non-specific fetal abnormalities could be demonstrated. All women with normal abdominal and vaginal sonograms in the first trimester were rescreened transabdominally at mid-gestation. Five patients with a variety of fetal anomalies, including hydrocephalus, agenesis of corpus callosum, bilateral ureteropelvic junction obstruction, right heart hypoplasia and tetralogy of Fallot, were identified in the rescreening procedure. One case of ventricular septal defect and coarctation of the aorta was not detected at either of the first or second screening procedures. Our findings show that transvaginal sonography is more sensitive than transabdominal sonography in the detection of first-trimester anomalies. However, since not all fetal anomalies are manifest so early in pregnancy, standard abdominal sonography in the second trimester is still recommended. Copyright 1991 International Society of Ultrasound in Obstetrics and Gynecolog.

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