Publications by authors named "Wolman Igal"

25 Publications

  • Page 1 of 1

A unique brain germinal matrix involvement in cytomegalovirus infected fetuses: A retrospective neurosonographic analysis with outcome correlation.

Prenat Diagn 2021 Jun 5;41(7):877-883. Epub 2021 Feb 5.

OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Objective: To study the clinical significance of brain germinal matrix (GM) changes in cytomegalovirus (CMV) infected fetuses.

Method: This is a retrospective analysis. Group A; isolated GM finding, with or without lenticulostriatal vasculopathy (LSV). Group B; non-isolated lesion. Amniocentesis, urinalysis, postnatal US and developmental assessment, were obtained.

Results: Group A and B included 18 and four fetuses, respectively. In group A, mean fetal age at diagnosis was 34.3 weeks (31-38 weeks). In 15/18 (83.3%), the lesion was bilateral and LSV was present in 8/18 (44.4%). Small cysts appeared inside the lesion in 5/18 (27.7%). MRI was normal in 8/18 (44.4%). Subtle or inconclusive findings were reported in the remaining fetuses. Brain ultrasound was normal in 10/18 (55.5%) of newborns. In the remaining, caudothalamic cyst with or without LSV, or isolated LSV were found. All newborns are developing normally at a mean follow-up age of 33.3 months (+/- 19.6 moths). In group B, all four patients requested for termination of pregnancy.

Conclusion: Fetal CMV infection may cause focal GM changes, frequently accompanied by LSV, late in pregnancy. These changes may be isolated, or as part of a more generalized brain damage. When isolated, favorable prognosis is expected.
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http://dx.doi.org/10.1002/pd.5888DOI Listing
June 2021

The early pattern of human corpus callosum development: A transvaginal 3D neurosonographic study.

Prenat Diagn 2020 09 2;40(10):1239-1245. Epub 2020 Jun 2.

OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Objective: To provide an in-vivo description of early corpus callosum (CC) development.

Methods: We reviewed 3D US volumes acquired transvaginally (TVUS) through the anterior fontanelle, between 14 to 17 weeks. The following landmarks were recognized: tela-choroidea (TC), foramina of Moro, early CC and the evolving cavum septi pellucidi. The following measurements were taken: total, anterior and posterior sections, and height of the CC (referenced to the anterior TC border). All measurements were correlated to both the gestational age and the transverse cerebellar diameter (TCD).

Results: Eighty nine volumes were included in the study (mean 15.1 weeks ± 0.84, TCD range, 13.1-18.4 mm) with high inter and intra observer correlation of the measurements. We found high correlation between CC length and height, and TCD. The anterior segment of the CC appear earlier than the posterior one, and growth continues bi-directionally. Initially, the posterior elongation is significantly larger than the anterior one. Association of all CC measurements with TCD remained significant when co-varying for maternal age and fetal sex.

Conclusions: imaging the fetal CC is feasible from 14 weeks by TVUS, by following the suggested insonation approach. The early CC develops bi-directionally, and the posterior elongation is more significant than the anterior one.
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http://dx.doi.org/10.1002/pd.5735DOI Listing
September 2020

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation.

Prenat Diagn 2020 03 24;40(4):447-453. Epub 2020 Feb 24.

OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Objective: To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy.

Methods: This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment.

Results: For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy-four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false-positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient.

Conclusion: Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false-positive rate.
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http://dx.doi.org/10.1002/pd.5634DOI Listing
March 2020

Ultrasound imaging of the fetal secondary palate: Methodological description of a two-dimensional approach and a case series.

Prenat Diagn 2018 12;38(13):1049-1054

OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Objective: The study aims to describe our two-dimensional (2D) ultrasound approach to visualize the fetal secondary palate and plot its growth curve and to describe and demonstrate its clinical implementation.

Methods: This is a two parts retrospective study. First, we measured the antero-posterior length of the bony secondary palate, from the soft to hard palate interface (SHPI) line to the alveolar ridge, blindly by two operators during routine scans of low-risk fetuses, and plot a longitudinal growth curve. In the second part, we describe four cases of prenatal diagnosis of secondary palate cleft.

Results: Sixty-eight fetuses were included: 14 to 15 weeks (n = 20), 21 to 24 weeks (n = 32), and 29 to 35 weeks (n = 16). The bony secondary palate elongates along gestation from a mean of 5.3 mm (+/-0.46 mm) at 14 to 15 weeks to 15.9 mm (+/-1.7 mm) at 29 to 35 weeks. We found high intraobserver and interobserver correlation between measurements. All four cases diagnosed by this approach were confirmed postnatally.

Conclusions: The SHPI, representing the normally developed secondary bony palate, can be imaged in the fetus by direct 2D ultrasound as early as 14 weeks. A gap within or nonvisualization of the SHPI is highly suggestive for a secondary palate cleft.
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http://dx.doi.org/10.1002/pd.5385DOI Listing
December 2018

Early Transient Prenatal Ultrasound Features of Choanal Atresia.

J Ultrasound Med 2018 Oct 26;37(10):2439-2444. Epub 2018 Feb 26.

Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.

We present a case series of early second-trimester prenatal ultrasound (US) features in 4 fetuses with a confirmed diagnosis of choanal atresia. The clinical characteristics and outcomes evaluated included prenatal US findings, genetic analyses, postmortem autopsies (2 cases), and computed tomographic findings. A transient large nasal cavity was detected by US in all 4 fetuses. This finding disappeared a few weeks later. Three cases were unilateral choanal atresia, and 1 was bilateral. Transient enlargement of the nasal cavity in early pregnancy appears to be a US sign of choanal atresia.
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http://dx.doi.org/10.1002/jum.14586DOI Listing
October 2018

Detection Rate and Sonographic Signs of Trisomy 21 Fetuses at 14-17 Weeks of Gestation.

Isr Med Assoc J 2017 Jan;19(1):8-12

Department of Obstetrics.

Background: Early prenatal ultrasound is an important part of prenatal screening in Israel. No studies have described the rate of trisomy 21 [T21] identification at 14-17 weeks gestation.

Objectives: To describe the rate of T21 identification by transvaginal sonograms (TVS) at 14-17 weeks gestation.

Methods: We conducted a historical prospective study. Since 1986, early TVS of 72,000 fetuses at 14-17 weeks gestation have been prospectively recorded together with prenatal screening data at a private ultrasound center (AL-KOL, Haifa). We calculated the fraction of T21 cases by dividing the total number of cases with abnormal sonographic findings by the total number of diagnosed T21 cases. We also examined the percentage of verified T21 cases that had completely normal prenatal screening tests prior to the early prenatal TVS, thus revealing the contribution of this examination to the existing prenatal screening. Fisher's exact test was used to calculate odds ratios for each sonographic marker.

Results: Of 137 T21 fetuses, 123 had sonographic markers on early TVS, yielding a prediction capability of at least 89.87%. Of all T21 cases, 14% had completely normal nuchal translucency/first-trimester screening prior to the abnormal 14-17 week TVS findings. Isolated abnormal sonographic findings, which were found to increase the risk for T21, were common atrioventricular septal canal (odds ratio 88.88), duodenal atresia (OR 88.23), nuchal edema (OR 39.14), and hydrocephalus (OR 15.78). Fetal hydronephrosis/pyelectasis was non-significant when isolated (OR 1), and cardiac echogenic focus was associated with a decreased risk (OR 0.13).

Conclusions: Early prenatal TVS at 14-17 weeks may identify almost 90% of T21 and adds 14% to the identification rate at the first-trimester screening.
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January 2017

Intrapartum sonographic assessment of labor.

J Obstet Gynaecol India 2013 Oct 9;63(5):297-300. Epub 2013 Oct 9.

Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

Fetal head progression during labor is difficult to assess. Digital examination has been shown to be an inaccurate method. Utilizing the ultrasound technology in the delivery room can standardize the way we assess head progression. Intrapartum ultrasound is applicable, for the assessment of the progression of labor and assists the obstetrician, in decision making regarding the need for an assisted delivery. This article summarizes the latest studies regarding the usage of ultrasound in the delivery room and the measurements that are used during delivery.
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http://dx.doi.org/10.1007/s13224-013-0479-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798440PMC
October 2013

Ultrasonographic evidence of intra-abdominal umbilical vein dilatation: is it a true varix?

Ultrasound Med Biol 2012 Mar 20;38(3):412-6. Epub 2012 Jan 20.

Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center,Tel Aviv, Israel.

Fetal intraabdominal umbilical vein (FIUV) dilatation, or varix, is a rare ultrasonographic (US) finding of focal dilatation of the umbilical vein. This article describes FIUV tortuosity in cases with suspected varix and provides ultrasonographic criteria for its diagnosis. Cases of suspected FIUV varix referred to our unit for final diagnosis and follow-up were studied. Each woman underwent comprehensive US evaluations that included basic grayscale scan and color Doppler scan. In 12 singleton pregnancies, primary grayscale scan confirmed FIUV dilatation. Supplementary color Doppler scans, however, revealed linear bidirectional blood flow and FIUV tortuosity in all cases. Color Doppler scans did not depict true FIUV dilatations or varix but rather a tortuous course of the vein. A normal pregnancy outcome can be expected in these cases.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2011.09.019DOI Listing
March 2012

A prospective follow-up of two 21/7 cycles followed by two extended regimen 84/7 cycles with contraceptive pills containing ethinyl estradiol and drospirenone.

Isr Med Assoc J 2010 Jul;12(7):400-5

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.

Background: Continuous use of combined oral contraceptives is currently attracting growing interest as a means of improving menstrual related symptoms and reducing the number of bleeding days.

Objectives: To evaluate bleeding patterns, menstrual symptoms and quality of life with an extended 84/7 oral contraceptive regimen versus 21/7 cycles.

Methods: In two consecutive run-in cycles, 30 microg ethinyl estradiol and 3 mg drospirenone tablets taken on days 1-21 were followed by a tablet-free period from days 22 to 28 of each cycle and then by two 84 day cycles of pill use with a 7 day tablet-free interval. The primary outcome was the total number of bleeding/spotting days. Secondary outcomes were severity of daily symptoms, general well-being determined by the PGWBI questionnaire, and overall treatment satisfaction.

Results: Of the 137 women invited to participate in the study 109 (aged 18-40 years) were enrolled. The number of bleeding days decreased by about one-third from a calculated 31.8 days of bleeding under a cyclic 21/7 regimen to an expected total of 21.8 days for the extended 84/7 regimen. The incidence of menorrhagia, intermenstrual bleeding, dysmenorrhea, abdominal bloating, breast tenderness, depressive moods and irritability - when compared at enrollment and at the end of the second extended study period--was significantly lower (P < 0.005) among women on the continuous pill regimen. The median (range) global PGWBI scores were not substantially different before and after the extended use cycles: 78.2 (39.1-96.4) and 77.3 (30.9-96.4), respectively. Body weight and skin condition also remained constant. At the completion of the study: 65.5% of the women were either highly satisfied (41.4%) or satisfied (24.1%) with the extended regimen.

Conclusions: The extended 84/7 regimen was found to be satisfactory for the majority of participants and was associated with a decrease in the number of bleeding days and an improvement in menstrual symptoms compared to 21/7 cycles.
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July 2010

Embryo transfer using the SureView catheter-beacon in the womb.

Fertil Steril 2010 Feb 6;93(2):344-50. Epub 2009 Mar 6.

Rotunda, the Center for Human Reproduction, 672 Kalpak Gulistan, Master Vinayak Road, Opp Brah-makumari Garden, Bandra (West), Mumbai 400050, India.

Objective: To compare the performance of the SureView catheter, a new ultrasonic embryo transfer (ET), with the classic Wallace catheter during ultrasound-guided ET.

Design: Prospective, randomized study.

Setting: Private, academically affiliated clinic.

Patient(s): 175 patients undergoing donor egg in vitro fertilization with ET (IVF-ET).

Intervention(s): Ultrasound-guided ET by a single physician with a standardized technique randomly using one of the two catheters.

Main Outcome Measure(s): Implantation rate, pregnancy rate, ease of transfer, and visualization of catheter.

Result(s): The echo-dense tip and the entire length of the SureView catheter were consistently seen with ultrasound guidance. Visualization was statistically significantly better, but there was no statistically significant difference with regard to the ease of transfer. Comparing the SureView with the classic Wallace catheters, the implantation rate (27.76% vs. 23.56%, respectively) and clinical pregnancy rate (41.02% vs. 43.29%, respectively) were similar in both groups. However, the physician using the SureView catheter noted a remarkably superior ease of transfer.

Conclusion(s): The SureView catheter with its ultrasonic contrast properties simplifies ultrasound-guided ET, but pregnancy rates are similar to those obtained when a classic Wallace catheter is used.
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http://dx.doi.org/10.1016/j.fertnstert.2009.01.090DOI Listing
February 2010

Combined clinical and ultrasonographic work-up for the diagnosis of retained products of conception.

Fertil Steril 2009 Sep 26;92(3):1162-1164. Epub 2009 Feb 26.

Ultrasound Unit in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Tel-Aviv Medical Center, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Retained products of conception (RPOC) present a major clinical challenge. We assessed the accuracy of an evaluation protocol based on clinical management and transvaginal ultrasonographic evaluation for the detection of retained products of conception. This combined clinical and sonographic evaluation protocol offers a high sensitivity for the accurate diagnosis of RPOC.
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http://dx.doi.org/10.1016/j.fertnstert.2009.01.087DOI Listing
September 2009

Cervical mucus status can be accurately estimated by transvaginal ultrasound during fertility evaluation.

Fertil Steril 2009 Sep 24;92(3):1165-1167. Epub 2009 Feb 24.

Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Examinations of the cervical mucus for determining its quantity and physical characteristics are used to provide a clinical marker for the timing of ovulation. We propose that transvaginal ultrasound, which is routinely used as a tool for monitoring follicular growth in patients undergoing ovulation induction, might also be used simultaneously for estimating cervical mucus measurements. With no additional effort or expense, these data may help to optimize individual patient management.
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http://dx.doi.org/10.1016/j.fertnstert.2009.01.077DOI Listing
September 2009

Evacuating retained products of conception in the setting of an ultrasound unit.

Fertil Steril 2009 Apr 6;91(4 Suppl):1586-8. Epub 2008 Dec 6.

Department of Obstetrics and Gynecology, Ultrasound Unit, Lis Maternity Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel.

Women who have retained products of conception are usually referred for curettage or hysteroscopy, both performed in most cases under general anesthesia in an operating theater and sometimes requiring hospitalization. We propose that for most of these patients the procedure can be just as safely and effectively carried out in an obstetric ultrasound unit.
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http://dx.doi.org/10.1016/j.fertnstert.2008.10.032DOI Listing
April 2009

Estradiol valerate as a possible endocrine reproductive disruptor: evidence from an in vivo rat model.

Fertil Steril 2009 Apr 29;91(4 Suppl):1510-2. Epub 2008 Oct 29.

Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, both affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

We used an in vivo rat model to demonstrate that low-dose intradermal exposure to E(2) valerate has an inverse effect on the female's estrus cycle pattern and can significantly reduce litter size. These results suggest that, under certain circumstances, environmental exposure to exogenous estrogens may play a role as an endocrine disruptor and adversely affect reproductive outcome.
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http://dx.doi.org/10.1016/j.fertnstert.2008.08.018DOI Listing
April 2009

Antibubble trajectory during embryo transfers in donor egg IVF does not predict success.

Reprod Biomed Online 2008 Jun;16(6):881-5

Rotunda - The Center For Human Reproduction, Bandra, Mumbai, India.

Transient motion of embryo transfer-associated antibubbles was observed. This prospective study was performed to determine if this antibubble movement can predict a successful outcome. Transabdominal ultrasound-guided embryo transfers were performed in 187 recipients receiving identical hormone replacement therapy. All embryo transfers were performed by the first author, using the Sureview embryo transfer catheter, in 30 mul of culture media. Observation was made of the catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. Ultrasound-guided tracking of antibubble within the uterine cavity was done immediately after the piston was depressed at the time of embryo deposition. The antibubble movement was upwards (group A) in 104 embryo transfers and downwards (group B) in 83 transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was observed. The clinical pregnancy rate was similar in both groups: 47.12% in group A versus 45.78% in group B. The total implantation rate/embryo transferred was 19.34% in group A compared with 20.07% in group B. The movement of the embryo transfer-associated antibubble is unlikely to be a factor in predicting success in donor egg IVF cycles.
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http://dx.doi.org/10.1016/s1472-6483(10)60156-3DOI Listing
June 2008

The clinical significance of postpartum transperineal ultrasound of the anal sphincter.

Eur J Obstet Gynecol Reprod Biol 2007 Sep 17;134(1):115-9. Epub 2006 Aug 17.

Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, Tel Aviv 64239, Israel.

Background And Objective: To evaluate the clinical significance of postpartum anal sphincter damage by transperineal ultrasonography (TPUS) performed on the day of delivery.

Methods: Continence questionnaires were handed out and TPUS was performed on 154 consecutive primiparous women 6-24h after vaginal delivery. At 2 and 6 months later, complaints and sphincteric sonographic appearance were reassessed. The puerperal women's clinical status and sonographic findings in the immediate and late postpartum period were evaluated.

Results: Thirty-five (23%) women complained of anal incontinence on the first postpartum day and anal sphincter damage was demonstrated by TPUS in 31 (89%) of them. Four women with anorectal complaints had an intact anal sphincter by TPUS. Follow-up questionnaires, 2 months later, revealed 30 symptomatic women: all of them had sonographically recognized tears on the initial TPUS and 27 of them had positive findings on the TPUS performed 2 months after birth. Six months after delivery, 27 women reported symptoms and all of them had sphincteric disruption evidenced on TPUS performed on the day of delivery. All the women with intact sphincter on the initial TPUS were asymptomatic 6 months later.

Conclusion: TPUS findings on the day of delivery are related to long-term anorectal complaints, supporting a potential role for TPUS as a screening aid for anal sphincter tears.
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http://dx.doi.org/10.1016/j.ejogrb.2006.06.017DOI Listing
September 2007

Cervical length, multifetal pregnancy reduction, and prediction of preterm birth.

J Clin Ultrasound 2005 Sep;33(7):329-32

Department of Obstetrics and Gynecology, U.S. Unit in Ob & Gyn, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman St., Tel Aviv 64239, Israel.

Purpose: To evaluate the application of transvaginal sonography assessment of cervical length before fetal reduction for predicting spontaneous preterm birth in triplet gestations reduced to twins.

Methods: This retrospective study was conducted at the ultrasound unit of a university-affiliated municipal hospital. The study cohort consisted of 25 women with triplet gestations following ovulation induction or assisted-reproduction techniques who underwent fetal reduction to twins. Cervical length was assessed via transvaginal sonography before fetal reduction, and data on pregnancy outcome were retrieved from maternal records and/or maternal interviews.

Results: Cervical length (mean +/- SD) at reduction was 4.0 +/- 0.85 (range: 1.2-5.5). Five women were excluded from statistical evaluation because pregnancy complications precluded spontaneous delivery. Two of 3 (67%) women with a cervical length of <3.5 cm delivered prior to 33 weeks' gestation compared with 1/17 (6%) women with a cervical length > or = 3.5 cm. This difference was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of cervical lengths <3.5 cm to predict delivery prior to 33 gestational weeks was 67%, 94%, 67%, and 94%, respectively.

Conclusions: Measurement of cervical length in triplet pregnancies before fetal reduction provides useful predictive information on the risk for preterm delivery.
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http://dx.doi.org/10.1002/jcu.20159DOI Listing
September 2005

Nomograms for the sonographic measurement of the fetal philtrum and chin.

Fetal Diagn Ther 2005 Mar-Apr;20(2):127-31

Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel.

Objective: To generate nomograms for the sonographic measurement of the fetal philtrum and chin during pregnancy.

Design: A prospective, cross-sectional study in normal singleton pregnancies.

Subjects: One hundred and fifty-three fetuses between 13 and 42 weeks of gestation were studied.

Methods: The philtrum was measured from the base of the columella to the upper lip. The chin was measured from the tip of the lower lip to the skin under the lower tip of the mandible. Predictive models were evaluated to generate graphic description of the 5th, 50th and 95th centiles for the fetal philtrum and chin.

Results: Fetal philtrum length increased with gestational age. The regression equation for the philtrum length (y) according to gestational age in weeks (x) is best predicted by the S-curve (Gompertz) model, as described by the following equation: y = exp(a + b/x), where a = 2.778577, and b = -23.476723 (R(2) = 85.3%, p < 0.0001). The fetal chin length increased with gestational age. The regression equation for the mean chin length (y) according to gestational age in weeks (x) is best predicted by the S-curve model as described in the following equation. y = exp(a + b/x), where a = 3.7922, b = -28.043, (R(2) = 89.0%, p < 0.0001).

Conclusions: The nomograms generated in this study for the fetal philtrum and chin during pregnancy can be used in confirming subjective impression of facial dysmorphism.
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http://dx.doi.org/10.1159/000082436DOI Listing
June 2005

Cervical length in the early second trimester for detection of triplet pregnancies at risk for preterm birth.

J Ultrasound Med 2004 Sep;23(9):1187-91

Gynecologic Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Israel.

Objective: Preterm triplet delivery is common and has a tremendous impact on neonatal mortality and morbidity. We aimed at assessing early second-trimester cervical length as a means of detecting triplet pregnancies at risk for preterm birth.

Methods: Cervical length was measured in triplet pregnancies during weeks 14 to 20. Cervical length of less than 25 mm was used as a cutoff to divide individuals into 2 groups. Perinatal outcome parameters were compared between the 2 groups and included gestational age at delivery, birth weights, and neonatal intensive care unit admission rates. Sensitivity, specificity, and positive and negative predictive values were calculated for cervical length as a screening method for preterm birth.

Results: We evaluated 36 triplets during weeks 14 to 20. Cervical length of less than 25 mm was measured in 14 (group I), 12 of which were delivered before 32 weeks (mean +/- SD, 28.4 +/- 3.1 weeks). Four of 22 women with cervical length of greater than 25 mm (group II) had delivery before 32 weeks (mean, 30.1 +/- 1.8 weeks). The mean gestational age at delivery for all parturients from group II was 33.1 +/- 2.1 weeks (P < .05). Group I neonates had lower birth weights (972 versus 1889 g; P < .001) and higher rates of low 5-minute Apgar scores and neonatal intensive care unit admissions compared with group II neonates. The sensitivity of a shorter cervix as a predictor of preterm labor was 75%, with specificity of 90%, a positive predictive value of 83%, and a negative predictive value of 81%.

Conclusions: Cervical length of less than 25 mm at 14 to 20 weeks' gestation is associated with preterm delivery and adverse perinatal outcome in triplet pregnancies.
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http://dx.doi.org/10.7863/jum.2004.23.9.1187DOI Listing
September 2004

Renal blood flow alteration after paracentesis in women with ovarian hyperstimulation.

Obstet Gynecol 2004 Aug;104(2):321-6

Department of Obstetrics and Gynecologic, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Objective: To evaluate renal arterial resistance to flow by Doppler indices concurrently with ascites drainage in women with severe ovarian hyperstimulation syndrome.

Methods: We conducted an interventional clinical study of 19 women with severe ovarian hyperstimulation syndrome, manifested by free peritoneal fluid. The subjects were evaluated before and after therapeutic paracentesis by measuring urine output, blood urea nitrogen, intra-abdominal pressure, and renal artery flow measures by Doppler ultrasonography (systolic/diastolic ratio [S/D] and resistance index).

Results: An average of 3,340 mL of ascitic fluid was drained, and the intra-abdominal pressure decreased from 17.5 +/- 1.24 cm H2O to 10 +/- 1.22 cm H2O. Urine output was increased (by 65%, from 925 +/- 248 mL/d before paracentesis to 1,523 +/- 526 mL/d on the day after paracentesis, P <.001). The mean renal arterial S/D decreased from 3 +/- 0.15 to 2.29 +/- 0.13 (P =.001). Most of the decrease in intra-abdominal pressure as well as in renal vasculature resistance was apparent after an initial drainage of 2,000 mL. Additional fluid drainage had only negligible effect on intra-abdominal pressure and renal flow.

Conclusion: Paracentesis lowered intra-abdominal pressure and decreased renal arterial resistance (lowered S/D and resistance index), ultimately resulting in increased urine production. It is plausible that the beneficial effects of paracentesis on urine output in ovarian hyperstimulation syndrome are due to improved renal blood flow from a direct decompression effect.
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http://dx.doi.org/10.1097/01.AOG.0000129956.97012.0dDOI Listing
August 2004

Feasibility of nuchal translucency in triplet pregnancies.

J Ultrasound Med 2004 Apr;23(4):501-4

Gynecologic Ultrasound Unit, Lis Maternity Hospital, Tel Aviv University, Tel Aviv, Israel.

Objective: To assess the feasibility of nuchal translucency in triplets compared with singletons.

Methods: Nuchal translucency thickness as part of routine first-trimester screening in the general population was compared between 3128 singleton pregnancies and 51 triplets (153 fetuses). Crown-rump length was also noted. The 5th, 50th, and 95th percentiles were determined and compared between the 2 groups, and regression curves of nuchal translucency measurements plotted against crown-rump length were drawn.

Results: The mean nuchal translucency thickness was 1.23 mm for singletons and triplets. The 5th and 95th percentiles were also the same between the 2 studied groups. The regression curves of 5th, 50th, and 95th percentiles of nuchal translucency plotted against crown-rump length of triplets and singletons overlapped.

Conclusions: Nuchal translucency values and distribution are the same in triplets and singletons, validating the utility of the cutoff values.
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http://dx.doi.org/10.7863/jum.2004.23.4.501DOI Listing
April 2004

Effect of 1 week of oral hydration on the amniotic fluid index.

J Reprod Med 2003 Mar;48(3):187-90

Department of Obstetrics and Gynecology, Lis Maternity Hospital, 6 Weitzman Street, Tel Aviv, 64239 Israel.

Objective: To evaluate the effect of long-term (1-week) oral hydration on amniotic fluid volume in women with an amniotic fluid index (AFI) < 10th percentile.

Study Design: This prospective, nonrandomized, interventional study was conducted on 30 women with AFI < 10th percentile. Study inclusion criteria were singleton pregnancy, well-established gestational age, intact membranes, no maternal complications (e.g., hypertension, cardiovascular disease, hyperthyroidism), no evidence of preeclampsia, no fetal structural malformations and no evidence of fetal distress. The women were instructed to drink at least 2L of water daily; their AFI was evaluated before and 1 week after the initiation of oral hydration. The study group was compared to a control group of 30 women matched for age and gestational age, with AFI > 10th and < 90th percentile.

Results: AFI increased from 8.1 +/- 0.73 (mean +/- SD) to 11.8 +/- 2.4 1 week later (P < .01) in 25 (83%) of the study subjects. The AFI was similar before and 1 week after oral hydration in all the controls.

Conclusion: Long-term maternal oral hydration seems to significantly increase the AFI in selected women with reduced fluid and possibly prevents oligohydramnios.
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March 2003

Tension-free vaginal tape for stress urinary incontinence: Is there a learning curve?

Neurourol Urodyn 2002 ;21(5):470-2

Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Aim: To assess the learning curve characteristics of the first 30 tension-free vaginal tape (TVT) procedures carried out in our medical center and to evaluate its safety and short-term effectiveness.

Methods: A total of 30 incontinent women with urodynamically proven SUI were enrolled. None had undergone any previous anti-incontinence procedure. All were operated on by one surgeon, in accordance with the technique described by Ulmsten et al. in 1996. Mean follow-up was 11.4+/- 3.6 months (range, 5-17 months).

Results: Five (17%) bladder perforations occurred at the beginning of the study, due to inadvertent insertion of the applicator. All perforations were identified by intraoperative cystoscopy. Five other patients (17%) had increased intraoperative bleeding (>200 mL) necessitating vaginal tamponade. Blood transfusions were not required. Eight (27%) patients had immediate postoperative voiding difficulties, necessitating catheterization for 2-10 days, but none needed long-term catheterization. There was no local infection or rejection of the Prolene tape was found. All patients were subjectively cured of their stress incontinence; however, urodynamic evaluation revealed "asymptomatic genuine stress incontinence" in one patient. Sixteen of 21 patients (80%) with preoperative urge syndrome, had persistent postoperative symptoms. No patient developed de novo urge incontinence.

Conclusion: The TVT operation is a new, minimally invasive surgical procedure with excellent short- and medium-term cure rates. However, there is a definite learning curve, and we believe that the operation should only be performed by experienced surgeons.
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http://dx.doi.org/10.1002/nau.10056DOI Listing
February 2003

Sonographic detection of undescended testes in the third trimester.

J Ultrasound Med 2002 Jan;21(1):15-8; quiz 20

Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Objective: To assess the sonographic detection rate of fetal undescended testes among a low-risk population during the third trimester.

Methods: A sonographic evaluation, which included biometric studies and a detailed examination of the fetal genitalia, was performed prospectively on 332 male fetuses of singleton pregnancies between 34 and 40 weeks' gestation. A qualified neonatologist examined the presence of the testes within the scrotum within 3 days after birth.

Results: The scrotum was visible in 294 (89%) of the 332 fetuses who were examined. It was visible in all fetuses evaluated between 34 and 36 weeks' gestation. Nine cases of undescended testes were detected (3%). Of these, the diagnosis of 1 case, examined at 34 weeks' gestation, was revealed after birth to be false-positive. There were no false-negative results.

Conclusions: Sonographic examination during the late third trimester of pregnancy appears to allow accurate diagnosis of undescended testes prenatally. This early identification will alert the neonatologist of the possibility of cryptorchidism and will permit early postnatal identification and treatment.
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http://dx.doi.org/10.7863/jum.2002.21.1.15DOI Listing
January 2002