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Biomedical subjects

M Bronshtein

Publications and source records attributed to M Bronshtein.

At least 19 recordsLinked to original sources
PubMed2004

Sonographic imaging of cervical scars after Cesarean section.

OBJECTIVE: To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar. METHODS: A targeted transvaginal ultrasound examination of the fetus, uterus and cervix was done in 2973 consecutive women at 14-16 weeks' gestation. The sonographer was blinded to the women's previous obstetric histories. The presence and location of a sonographic cervical hypoechogenic line, which probably represented a Cesarean scar, was recorded. RESULTS: There were 180 women with a previous Cesarean section performed before the start of uterine contractions and 173 with a Cesarean section performed during contractions in labor. The cervical hypoechogenic line was more common in sections performed during contractions (75.7% vs. 52.7%; P < 0.001) and was more distally located from the internal os (17.9 +/- 9.4 vs. 14.6 +/- 9.1 mm; P = 0.01). A hypoechogenic line was observed in 21/2620 women without a previous Cesarean section, representing a false-positive rate of 0.8%. CONCLUSION: Cesarean sections, especially those done during uterine contractions, are actually performed through cervical tissue. This finding is in agreement with the physiological process of cervical effacement during contractions.

Cervix Uteri↗
PubMed2002

The sonographic approach to the detection of fetal cardiac anomalies in early pregnancy.

BACKGROUND: Transvaginal sonography enables imaging of the fetal heart in various planes and directions in early pregnancy. This study summarizes our experience in early detection of fetal cardiac anomalies. METHODS: Transvaginal sonographic examination was performed in 36 323 consecutive fetuses in both high- and low-risk pregnancies. More than 99% of cases were evaluated at 14-16 weeks' gestation. Examination of the cardiovascular system did not rely on still images of the classic views but instead was performed in a dynamic mode visualizing the heart and great vessels from different directions and in various scanning planes. RESULTS: Cardiac anomalies were detected in 173 fetuses, giving an overall incidence of 1 in 210 pregnancies. In 44% of these, the cardiac anomaly was isolated. An abnormal karyotype was detected in 27 of the 72 cases that underwent chromosomal analysis. An abnormal nuchal translucency finding was observed in 59 fetuses. The sonographic diagnosis was confirmed after delivery or at postmortem in 90 cases. Ten fetuses had a cardiac anomaly which differed from the anomaly suggested by sonography. In the remaining cases, a postmortem examination was not possible because termination of pregnancy was performed by dilatation and curettage. In four cases we did not detect the cardiac anomaly in early pregnancy. Two of them were detected at rescanning in mid-pregnancy. CONCLUSION: Early detection of fetal cardiac anomalies is now possible. Most anomalies occur in low-risk pregnancies. We suggest performing a detailed early multidirectional dynamic continuous sweep ultrasound examination of the fetal cardiovascular system in all pregnancies.

Coronary Vessel Anomalies↗
PubMed2002

Anomalies of the fetal aortic arch: a novel sonographic approach to in-utero diagnosis.

OBJECTIVE: To describe a novel, sonographic approach for in-utero evaluation of normal and abnormal aortic arch. METHODS: Aortic arch was evaluated by imaging of the axial view of the upper fetal mediastinum. The normal left aortic arch was defined by the V-shaped appearance of the junction between the ductus arteriosus and aortic arch, with the trachea situated posteriorly. Right and double aortic arches were diagnosed when the great vessels appeared U-shaped, with intermediate location of the trachea. RESULTS: Between 1997 and 1999, 18 347 women were scanned in three prenatal centers, and pathological findings were prospectively recorded. In a retrospective analysis of the records, we identified 19 fetuses (0.1%) with atypical, U-shaped appearance, and no other structural abnormalities present. With the exception of one fetus with a ventricular septal defect, no congenital cardiac defects were present. Right aortic arch was found in 18 cases, while color Doppler made it possible to diagnose one case with double aortic arch, and one fetus was demonstrated as having Kommerell's diverticulum. In all 18 cases, a left descending aorta and left ductus arteriosus were present, the latter coursing to the left of the trachea, forming a loose partial vascular ring. All were asymptomatic at birth and early infancy. The fetus with double aortic arch that had a true vascular ring underwent early infantile correction. CONCLUSIONS: It is possible to diagnose right and double fetal aortic arch using prenatal ultrasound. The use of color Doppler facilitated in-utero evaluation of possible complications, such as true vascular ring.

Adolescent↗
PubMed2001

Isolated hyperechogenic foci in the fetal thalamus in early pregnancy.

OBJECTIVE: To describe the sonographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region. METHODS: A detailed sonographic survey was performed in 46,244 consecutive pregnancies. Both low- and high-risk pregnancies were included. Transvaginal examinations were performed at 14-16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation. RESULTS: Isolated hyperechogenic foci in the thalamic region were observed in seven fetuses. All cases were diagnosed at 14-16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2-4 mm. A serologic work-up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid-pregnancy in all cases, and fetuses were normal at delivery and on follow up to the age of 9 years. CONCLUSIONS: Isolated hyperechogenic foci in the thalamic region in early pregnancy are probably benign in nature.

Female↗
PubMed2000

Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant.

OBJECTIVE: To evaluate outcomes of fetuses with antepartum sonographic diagnoses of persistent intrahepatic right umbilical veins. METHODS: A detailed fetal sonographic examination was done in 30,240 consecutive pregnancies at 14-26 weeks' gestation. High- and low-risk pregnancies were included and persistent right umbilical veins specifically were recorded. RESULTS: Sixty-nine fetuses had persistent intrahepatic right umbilical veins, of which 60 had no additional sonographic abnormalities, four had transient nuchal findings, and four had minor anomalies or anatomic variants. Only one of the 69 fetuses had a major anomaly (diaphragmatic hernia), and died after surgery. The remaining 68 fetuses were normal and healthy after birth. CONCLUSION: Persistent intrahepatic right umbilical vein is a fetal anatomic variant that is not rare and usually associated with a favorable outcome.

Female↗
PubMed2000

Fetal polydactyly diagnosis during early pregnancy: clinical applications.

OBJECTIVES: This study was undertaken to assess the incidence of fetal polydactyly observed by ultrasonography and to evaluate the outcome of these fetuses. STUDY DESIGN: Detailed ultrasonographic examinations were performed in 17,760 consecutive pregnant women. Both low- and high-risk pregnancies were included in the study. Most examinations were carried out at 14 to 16 weeks' gestation. RESULTS: Twenty-six fetuses with polydactyly were observed. Ten fetuses had either associated anomalies or polydactyly of the feet, or both, and those pregnancies were terminated. The other 16 fetuses had isolated polydactyly and a normal karyotype. Fourteen of them had postaxial polydactyly type B. The outcomes of fetuses with isolated polydactyly were usually favorable. There was 1 intrauterine death and there were 2 terminations of pregnancy. Four infants were born with polydactyly. In utero autoamputation of extra digits occurred in 2 cases, whereas in the remaining infants only a small residual bump was noted. CONCLUSIONS: Isolated fetal postaxial polydactyly type B is associated with a favorable outcome.

Abortion, Induced↗
PubMed1999

The possible impact of a myomatous uterus on the accuracy of fetal biometric measurements.

OBJECTIVE: The propagation speed of ultrasound beams changes in different media. The aim of the study was to assess the possible measurement error of fetal biometry performed in cases of a myomatous uterus. DESIGN: Three iron phantoms of 30 mm, 50 mm and 70 mm were measured by ultrasound. Each phantom was measured by three different transducers of 3.5 MHz, 6.5 MHz and 7.5 MHz. Measurements were performed in a water bath and the intraobserver variability was assessed. Thereafter phantoms were measured with one of their edges covered by a specimen of a myomatous uterus while their other edge was covered with water. RESULTS: Artifactual lengthening of the phantoms' size was observed in measurements performed with the uterine myoma. The measurement errors were inversely related to the length of the phantoms and became statistically significant in the phantoms of 30 mm (13.15 +/- 3.16% without the myoma vs. 17.38 +/- 4.39% with the myoma; p < 0.0001). Measurement errors were independent of the transducer type (p = 0.001, p = 0.01 and p = 0.014 for the 3.5-MHz, 6.5-MHz and 7.5-MHz transducers, respectively). CONCLUSIONS: Ultrasound measurement errors are expected while examining small fetal organs which are partially overshadowed by a myoma.

Embryonic and Fetal Development↗
PubMed1999

Natural history of fetal simple renal cysts detected in early pregnancy.

PURPOSE: In this 12-year prospective, longitudinal study we investigated the natural history of fetal simple renal cysts identified by ultrasonography in early pregnancy. MATERIALS AND METHOD: A detailed sonographic examination of the fetus was performed between January 1987 and June 1998 in 29,984 consecutive pregnancies at 14 to 16 weeks of gestation. Amniocenteses and chromosomal investigations were done in all cases in which a simple renal cyst was detected in the fetus. Followup sonography was done in all cases of renal cyst during pregnancy, infancy and, when indicated, childhood. RESULTS: Simple renal cysts were diagnosed at 14 to 16 weeks of gestation in 28 fetuses (1/1,100 pregnancies, 0.09%). In 25 fetuses the cysts resolved during pregnancy. In 2 fetuses the cysts remained benign but persisted postnatally and in 1 a renal cyst that was initially defined as simple was the first sign of unilateral multicystic dysplastic kidney. Except for nonseptated cystic hygroma in 1 fetus, none of the others had associated anomalies of the urinary or other organ systems and no chromosomal anomalies. Postnatal followup in all cases revealed healthy children. CONCLUSIONS: A fetal simple renal cyst can be identified by ultrasonography in early pregnancy. In the absence of associated anatomical or chromosomal abnormalities, the majority of cysts will resolve during pregnancy without any sequelae. Given the transient nature of most fetal simple renal cysts detected in early pregnancy, it is possible that these cysts represent a distinct entity within the spectrum of cystic kidney diseases.

Female↗
PubMed1998

Twin gestation: is there a correlation between the location of the gestational sacs at the beginning of pregnancy, and the order of delivery.

OBJECTIVES: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy. STUDY DESIGN: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth. RESULTS: Thirty seven of 41 (90.2%) twins who were delivered vaginally (between 32 and 41 weeks' gestation), were born in the same order as that predicted by transvaginal sonography early in pregnancy. It was found that in this small series there was a dynamic in the amniotic sac location in twin gestations during pregnancy in only about 10% of the cases. CONCLUSIONS: In roughly 90% of twins, there is no dynamic in the location of the amniotic sacs during pregnancy, and the first twin at the beginning of pregnancy intrinsically remains.

Adult↗
PubMed1998

Sonographic diagnosis of fetal coarctation of the aorta at 14-16 weeks of gestation.

The prenatal sonographic diagnosis of coarctation of the aorta is difficult. The objective of this study was to present a simple and reliable marker of this anomaly in early pregnancy. In fetuses with coarctation of aorta who were scanned at 14-16 weeks' gestation, a significant discrepancy was observed between a large ductus arteriosus and a smaller aorta at their point of connection. This difference between the sizes of the vessels probably reflects the reduced blood flow through the aorta and the compensatory increase in blood flow through the right outflow tract in cases of coarctation of the aorta.

Aortic Coarctation↗
PubMed1998

Fetal mustache in early pregnancy.

OBJECTIVE: The aim of this study was to determine the incidence in an unselected population of a rod-like structure on the fetal upper lip (called a 'mustache') which we had previously observed as an incidental finding. A secondary aim was to determine whether this was associated with any abnormalities or abnormal outcomes. DESIGN: Prospective non-randomized study. SUBJECTS: Three thousand consecutive fetuses from an unselected population were scanned by one sonologist. METHOD: Transvaginal ultrasound examinations were performed at 14-16 weeks' gestation. Repeat sonographic examinations were performed at 20-22 weeks' gestation in cases where a mustache was detected, and these neonates were examined by a pediatrician after delivery. RESULTS: Seven of 3000 fetuses had a mustache-like structure on the upper lip. The 'mustache' disappeared later in gestation. No anomaly of the upper lip was detected after birth in these fetuses. CONCLUSION: A mustache-like structure on the fetal upper lip in early pregnancy probably represents a normal variant of lip development. It is likely to represent a delay in the normal process of lip fusion during embryonic life.

Embryonic and Fetal Development↗