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Biomedical subjects

Z Alfirević

Publications and source records attributed to Z Alfirević.

11 recordsLinked to original sources
PubMed2001

Thrombophilia and adverse pregnancy outcome.

Congenital and acquired thrombophilias are the most common predisposing factors for thromboembolism, but they may also contribute to pathophysiological processes involved in recurrent pregnancy loss, fetal death, intrauterine growth restriction, placental abruption, placental infarction, and pre-eclampsia. The most common thrombophilias are deficiencies of antithrombin III, protein C, and protein S, acquired protein C resistance, genetic mutation encoding for factor V Leiden, prothrombin gene, and inherited hyperhomocysteinemia, and antiphospholipid syndrome. Although adverse pregnancy outcomes are more common in women with thrombophilia, the current evidence does not support routine thrombophilia screening of all pregnant women. Selective thrombophilia screening may be justified in certain group of women, particularly those with a history of thromboembolism. More research is required to confirm or refute the causal link between thrombophilia and abnormal placentation, and assess effectiveness and safety of thromboprophylaxis in pregnant women.

Female↗
PubMed1995

[Echocardiography in the diagnosis and therapy of pulmonary embolism].

A 58 year old woman was admitted to this hospital because of retrosternal pain followed by dyspnea which developed a few hours prior to admission, and two week history of progressive intolerance of physical effort. Echocardiography was done which revealed enlarged cavity of the right atrium (59 x 54 mm) and right ventricle (46 mm) of the heart. (Scintigraphy showed numerous triangular lung zones of sharply decreased or completely absent perfusion. After the diagnosis of recurrent pulmonary embolism, the patient was treated with intravenous heparin at a dosage of 25000 a day for 10 days. Dyspnea settled within 48 hours of starting heparin, analysis of arterial blood gases became normal and the general condition of the patient improved. A repeated echocardigram showed a significantly reduced dilatation of the right atrium from 59 x 45 mm to 47 x 43 mm and decreased pulmonary hypertension from 110 mmHg, on admission, to 65 mmHg.

Anticoagulants↗
PubMed1990

The assessment of abnormal pelvic blood flow by transvaginal color and pulsed Doppler.

Transvaginal color Doppler was used to analyze a group of 19 healthy, 48 infertile and 8 postmenopausal women; 67 patients with uterine and 151 patients with adnexal masses, and 19 patients with a suspected ectopic pregnancy. The ultrasonographer had not been informed of other clinical findings and indications for operative treatment. A 5 MHz transvaginal color Doppler probe was used to visualize the pelvic anatomy and blood flow. Each arterial blood flow velocity was classified into either of two types. In the normal flow pattern, the diastolic flow component was absent or small and the value of resistance index (RI) was greater than 0.50. In the abnormal flow pattern, a large diastolic flow component was evident and the value of RI was less than 0.50. Transvaginal color and pulsed Doppler studies in confirmed malignant uterine masses had moderate accuracy (90.2%), with a sensitivity (55.6%) and specificity (100%); and in confirmed malignant adnexal masses high accuracy (100%), sensitivity (100%) and specificity (100%). Comparison of blood flow characteristics within benign and malignant tumor tissue revealed less impedance and higher velocity in cases of malignancy. Blood flow studies in both uterine arterias have not shown clinically important values. This method can be also used in the diagnosis of ectopic pregnancy.

Blood Flow Velocity↗
PubMed1989

Ultrasound diagnosis and evaluation of fetal tumors.

Fetal tumors represent a rare and heterogeneous group of abnormalities. A significant proportion of them can now be diagnosed by using modern high resolution ultrasonic equipment. During 15 years there were 57 fetal tumours detected prenatally. Hygroma colli is the most frequent fetal tumor. It should be emphasized that cystic hygroma generally carries poor prognosis, and after an early diagnosis, termination of pregnancy is most logical approach. Contrary to the general opinion our own experience showed that there are cases in which prognosis could be much better as illustrated with our 4 cases. All of the treated fetuses, after surgical resection, had normal development and are now on the age of 5, 4, 3 and 2 years of life. An ovarian cyst can be suspected if a fluid-filled structure is visualized next to a fetal kidney and female external genitalia are recognizable. The ultrasound finding suggestive of an ovarian cyst is that of a pelvic cystic or complex mass in a female fetus with normal kidneys and urinary bladder and a normal gastrointestinal tract. In most cases, the normal course of fetal ovarian cyst is a spontaneous intrauterine or postnatal involution. Prenatal diagnosis improves neonatal outcome by allowing an appropriate choice of the optimal time, mode and place of delivery in order to avoid accidental and unexpected intrapartum and postnatal complications. The management of a fetus affected by an ovarian cyst depends on the size and on the echo-pattern of the cyst. It remains unclear whether in utero puncture of the cyst and evacuation of its content should be justified in cases of particularly large ovarian cyst. In our opinion intrauterine procedure can be attempted in the presence of large cyst fulfilling the fetal abdomen. We have treated actively two cases of large ovarian cysts by ultrasonically guided puncture before delivery and both fetuses underwent surgery later without complications. If properly performed puncture of the cyst seems to be a low risk procedure in comparison to potential problems that cyst may cause to the fetus or by causing dystocia. Sacrococcygeal teratoma represents the most frequent tumor in the fetuses and newborns. Prenatal diagnosis is usually simple and based on the visualization of tumor of variable size and internal structure. Tumors may appear as completely cystic, mixed or predominantly solid with obvious calcifications. Cystic and calcified tumors are most likely to be benign. Obstetrical management of sacrococcygeal teratoma depends on numerous parameters which include size and texture of the tumor, and gestational age.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1989

Transvaginal color Doppler for the assessment of pelvic circulation.

Transvaginal color Doppler was used to analyse a group of 56 patients including 41 with proven pelvic masses and 15 infertility patients with normal pelvic anatomy. All patients were examined by ultrasound before laparoscopy or/and laparotomy. The ultrasonographer had not been informed of other clinical findings and indications for operative treatment. Comparison of blood flow characteristics within uterine fibromas and ovarian malignancies revealed less impedance and higher blood velocity in cases of malignancy. When predicting the malignant nature of pelvic tumors, no false-negative results were encountered, and only one false positive diagnosis of malignancy.

Color↗
PubMed1987

Color flow mapping in obstetrics.

Blood flow studies are now used extensively in evaluating fetal peripheral circulation. By using continuous and pulsed Doppler ultrasonic equipment the raw Doppler shifts caused by blood moving in the vessels can be analyzed in different ways. Spectral data can be used to estimate blood velocity and volume in the vessel, and pulsatility characteristics and turbulence. All these data are obtained from very restricted areas within the body so that aiming of the probe is critical, and obtaining data from an area requires long and tedious effort. Color flow mapping which has recently been introduced into clinical practice provides an overview of flow velocities and directions within an area. Color coded flow can be displayed by applying the moving target identification principle (as in radar) to an ultrasonic diagnostic instrument where sound waves are used instead of radio waves. The value of flow mapping has already been recognized in the diagnosis of congenital and acquired heart disease in adults and children. Direct visualization of intracardiac flow provides for a fast and accurate diagnosis of various cardiac defects, such as the ventricular septal defect, without cardiac catheterization. In the present study we have investigated the potential of color flow mapping in obstetrics. 211 pregnant women were examined between the 15th and 40th weeks of pregnancy. 193 of them had normal pregnancies; 18 were abnormal, including 11 cases of insulin dependent diabetes, 2 cases of Rh-immunization, 2 cases of nonimmunologic fetal hydrops, 2 cases of fetal cardiac structural defects and 1 case of intrauterine growth retardation. Intracardiac flow was clearly seen in 78% (35/45) of cases at the gestational age between the 20th and 24th weeks. After the 24th week the heart flow visualization rate gradually decreased to 31% (11/36) before term. In 2 cases of congenital heart abnormality flow mapping enabled clear visualization of reverse flow through the tricuspid valve and diagnosis of valvular insufficiency. The best results in studies of flow in peripheral vessels were obtained from umbilical vessels which were seen in all cases after the 15th week. The flow visualization rate was much lower when the fetal aorta, intrahepatic umbilical vein and internal carotid artery were studied. The comparison between the diameter of the umbilical vein measured on the B-scan and flow width in the same vessel showed no significant difference (t = 0.26; p less than 0.01; N = 209).(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Flow Velocity↗
PubMedDate not supplied

[Doppler measurement of fetal blood flow. I. Normal values in the umbilical artery].

From October 1986 to October 1987 flow velocity waveforms (FVW) from the umbilical artery were measured in 260 healthy pregnant women. Measurements were performed by means of a Doppler ultrasound unit Kranzbuehler ADR 8130. A/B indices, RI (resistance index) and PI (pulsatility index), were used for the FVW analysis. The patients were divided into 6 groups according to the gestational age (20-23, 24-27, 28-31, 32-35, 36-37, 38-41 weeks of gestation). The value, standard deviation and coefficient of variability were calculated in each group for all three indices. The values obtained for groups 20-23 and 38-41 gestation week were compared and a significant decrease of the index values toward the end of pregnancy was observed (t A/B = 9.08, P less than 0.01; t RI = 9.33, P less than 0.01; t PI = 8.65, P less than 0.01). The finding suggests a decrease of peripheral resistance in the fetal circulation at the end of pregnancy. The nomograms obtained for the FVW umbilical artery suggest the clinical application of blood flow measurements possible in centres with adequate equipment but no capability to produce their own nomograms.

Blood Flow Velocity↗
PubMedDate not supplied

[Interventional ultrasound in obstetrics and gynecology].

During 1988 there were 1029 invasive obstetrical and gynecological ultrasonically guided procedures: 788 early amniocenteses and 84 late amniocenteses, 26 chorion villi sampling, 24 by transcervical and 2 by transabdominal route, 74 fetal blood sampling (chordocenthesis) mainly for fetal karyotyping, in 9 cases the assessment of the fetal acid-base status was the main indication for the procedure. There was one patient with the increased risk of epidermolysis bulosa in whom fetal skin biopsy was performed. Prostaglandine was administered intraamnially under ultrasound control in 44 cases, in which the second trimester termination of pregnancy was indicated for medical reasons. In 3 cases a huge polyhydramnion was evacuated and in one case of several fetal hydrocephaly, craniocentesis and aspiration of the cerebral fluid were performed. There was one selective fetocide in twin pregnancy with a large meningomyelocele in one twin. In one case of a nonimune fetal hydrops at the 27-week gestation, the aspiration of the accumulated fluid and the intraperitoneal injection of albumin at 27 and 34 weeks, respectively, were performed. A total number of 6 gynecological invasive ultrasonically guided procedures was done. Three of them were punctures of ovarian follicles as part of IVF programme, one puncture of a large simple ovarian cyst, and two aspirations of extrauterine pregnancy with the administration of Metotrexate.

Female↗