-Amniocentesis or chorionic villi sampling--when and why?-.
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Adult↗
Biomedical subjects
G Hebisch
Publications and source records attributed to G Hebisch.
[Comparative study of the lower uterine segment after Cesarean section using ultrasound and magnetic resonance tomography].
To determine whether ultrasound (US) or magnetic resonance imaging (MRI) gave more accurate and objective information about the thickness and continuity of scarred isthmical myometrium following previous Caesarean section (CS), US and MRI assessments of the scarred myometrium in 10 pregnant women (37-41 weeks gestation) after 1-8 CS were compared with each other and with findings at subsequent elective CS. Vaginal ultrasound gave more accurate information about the condition of the scarred isthmical myometrium than MRI, since US always allowed precise differentiation of isthmical myometrium from the urinary bladder wall and thus measurements of the scar thickness; there was a good correlation to intraoperative observations. MRI achieved better contrast resolution with T2- than T1-weighted and proton density-weighted spin-echo sequences. However, differentiation of the various tissues was either impossible (T1- and protondensity-weighted sequences) or less informative than with US. Image quality of body and posterior wall of the uterus was better with MRI (T2-weighted sequence) than with US.
Adult↗
[CT and MRI in inflammations of female genital organs].
Inflammatory disease of the female pelvis can be diagnosed both on the basis of clinical symptoms and complementary ultrasound. The role of CT and MRI is limited to complicated cases. CT guidance allows the biopsy needle to be localized precisely for diagnostic or therapeutic punctures. Furthermore, CT and MRI play an important role in the evaluation of prolonged puerperal fever of unknown origin: endomyometritis is associated with characteristic features in MRI, whereas puerperal ovarian vein thrombosis is best diagnosed using MR angiography. For other rare causes, MRI and CT have to be used according to clinical need.
Diagnosis, Differential↗
Effects of frequent ultrasound during pregnancy.
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Female↗
Evaluation of two enzyme immunoassays for rapid detection of group B streptococci in pregnant women.
The performance of two enzyme immunoassays for rapid detection of group B streptococci (GBS) was evaluated in comparison to culture using cervical swabs from 191 pregnant women. Ten percent of the women harboured GBS. There were two positive results in the Icon assay (Hybritech), both in women with heavy growth in the culture, and four positive results in the Quidel assay (Quidel), two in the women with heavy colonization and one each in women with moderate and light growth of GBS respectively. The sensitivity of both assays was low, being 11% (2/18) for the Icon assay and 24% (4/17) for the Quidel assay. The specificity of both assays was 100%. Both assays could detect > or = 10(6) group B streptococci per swab. A positive result justifies ampicillin prophylaxis due to the high risk for the newborn. A negative result should be confirmed by rapid culture techniques.
Carrier State↗
[New aspects in the evaluation of Doppler blood flow curves: three- dimensional image and analysis of Doppler shift frequencies within the heart cycle].
Since the introduction of Doppler ultrasound to the area of medical diagnostics, there have been numerous improvements and important technical refinements. In obstetrics, Doppler examination allows a more accurate and encompassing evaluation of the foetal condition than was previously possible. Combined with today's sophisticated computer technology, it has a great potential in research and to expand our knowledge about the physiology and pathophysiology of foetal and maternal haemodynamics. This paper describes a new way of integrating another factor into the evaluation of Doppler blood flow waveforms, namely, the intensities of various frequencies. One result should be more detailed information about the given haemodynamic situation; another, a valuable tool for the quality control of Doppler blood flow measurements. Although our work was on applications in the field of obstetrics, the method we have developed can be used in all medical areas.
Blood Flow Velocity↗
How good is ultrasound in the detection and evaluation of anterior abdominal wall defects?
The ability of routine obstetric ultrasound to detect and accurately describe fetuses with anterior abdominal wall defects has been examined in an unselected population using data from a regional abnormality survey. Examination between 16 and 22 weeks gestation detected 60% of defects with a false positive rate of 5.3%. Fetuses with gastroschisis were incorrectly assigned as exomphalos in 14.7% of cases recognized before 22 weeks gestation. The diagnosis, including description of associated detectable anomalies, was completely accurate in 71.6% of cases. Some of the problems of diagnostic accuracy need to be considered when counselling couples with a fetal anomaly. Cross-referral between obstetric ultrasound units should be encouraged to improve diagnostic accuracy. These results form the basis for audit of obstetric ultrasound in the diagnosis of fetal abnormality within a geographically defined population.
Abdominal Muscles↗
Umbilical artery blood flow velocity waveforms in twin pregnancies.
To detect discordant fetal growth in twin pregnancies and assess a possible role for Doppler ultrasound measurements of blood flow velocity waveforms in umbilical arteries in such cases, 32 twin pregnancies were examined on 125 occasions. The last examination was within 14 days of delivery. There was postpartum death of one pair of twins with the twin transfusion syndrome. Birthweight was appropriate for gestational age in 15 twin pairs, both infants were small for gestational age (SGA) in 5, and one of the infants was SGA in 12 twin pairs. The correlation coefficient of RI difference at the last examination and percentage birth weight difference in twin pairs was 0.68. Cutoff points for the delta RI and weight difference were established. The sensitivity of delta RI (0.1) was 77.8%; specificity, 95.8%; positive predictive value, 87.5%; and negative predictive value, 92.0%.
Blood Flow Velocity↗
Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis.
BACKGROUND: Septic puerperal ovarian vein thrombosis (SPOVT) is one of the underlying etiologies of puerperal fever. A correct diagnosis of this condition is important because adequate treatment requires additional administration of anticoagulants. The purpose of this study was to evaluate the role of duplex color Doppler ultrasound (CDUS), computed tomography (CT), and magnetic resonance angiography (MRA) in the detection of SPOVT. METHODS: Twenty-six patients with puerperal fever suspected to be due to SPOVT and unresponsive to broad antibiotic treatment for at least 48 h were included in a prospective study using CDUS, CT, and MR imaging including MRA. Examinations were analyzed and then correlated to a standard of reference gathered from surgical and clinical follow-up data and from results of imaging. RESULTS: SPOVT was present in nine patients (right side n = 8, bilateral n = 1). CDUS was inconclusive due to gaseous distention of the bowel or obesity in 13 of 26 cases. After counting inconclusive findings as wrong results for statistical purposes, sensitivity, specificity, and accuracy for CDUS were 55.6%, 41.2%, and 46.2%, respectively. CT had a sensitivity of 77.8% with a specificity of 62.5%; accuracy was 68.0%. MRA rendered conclusive results in all evaluated patients, resulting in a sensitivity and specificity of 100%. CONCLUSION: MRA is recommended in all patients with inconclusive CDUS findings and persistent suspicion for SPOVT. CT has the advantage of more rapid access and lower cost and thus will probably remain a sufficiently accurate alternative. Septic puerperal ovarian vein thrombosis (SPOVT)-Computed tomography-Magnetic resonance angiography-Ultrasound.
Adult↗
Fetal and preterm newborn cerebral blood flow velocity.
Using Doppler ultrasound, cerebral blood flow velocities (CBFV) in the first month of life of normoxemic preterm infants born in the 28th gestational week with stable circulatory conditions were examined. The results were compared with fetal CBFV in the 28th to 32nd weeks of pregnancy. Peak systolic (PSV), end-diastolic (EDV) and time averaged maximum velocities (TAMV) were evaluated from the Doppler shifts recorded from the middle cerebral artery (MCA). Cerebral circulatory changes in neonates in the first 4 weeks of life were much more pronounced than in fetuses at the corresponding gestational age (28-32 weeks). After the rapid increase in neonatal CBFV in the first 3 weeks of life, our results appear to indicate a stabilisation between the 3rd and 4th week (corresponding to the 32 gestational weeks). The significance of, and possible mechanisms for, these changes are discussed.
Blood Flow Velocity↗
[Two-stage delivery after spontaneous rupture of fetal membranes and delayed abortion of the first twin in conservative management].
INTRODUCTION: 1-2% of all twin pregnancies are complicated by premature contractions, leading to premature rupture of membranes before 26 weeks of pregnancy. In this situation, a decision is required to either actively induce premature delivery or to initiate expectant management. Maternal and fetal risks regarding perinatal mortality and morbidity and the benefits of pregnancy prolongation have to be weighted against each other. CASE REPORT: We present delayed deliveries of two I-Parae with dichorionic twin pregnancies, achieved by in vitro fertilisation. In both cases, spontaneous membrane rupture and miscarriage of the leading fetus occurred prior to 20 gestational weeks. As signs of infection were missing initially, we adopted a conservative, expectant management. In both cases, the pregnancies could be prolonged to more than 30 weeks' gestation. DISCUSSION: In the absence of additional risk factors, expectant, conservative management of multiple pregnancies after loss of one fetus can lead to pregnancy prolongation of 91 and 96 days, respectively. The gained gestational age of the remaining fetus and the healthy mother-child pairs are discussed under perinatal, economical and psychological aspects.
Abortion, Spontaneous↗
Multiple necrotic uterine leiomyomas causing severe puerperal fever: ultrasound, CT, MR, and histological findings.
The case of a patient with severe fever in the puerperium is presented. Ultrasound, CT, and MRI revealed multiple myomas; all the myomas, even the smallest ones, were hypodense on pre- and postcontrast enhanced CT and presented with high signal intensities on T2-weighted MRI. After hysterectomy, histology demonstrated necrosis of all leiomyomas without hemorrhage or inflammatory reaction. Therefore, fever was caused solely by extensive necrotic degeneration of the fibroids, probably due to hypoperfusion related to delivery or hormonal changes during pregnancy and puerperium.
Adult↗