Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
-
Ultrasound Obstet Gynecol · Jun 2002
Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits.
To assess whether the presence of a gestational sac or the width of the endometrium, can be used to predict the outcome of expectant management for an incomplete, first-trimester miscarriage, and to determine an appropriate schedule for follow-up visits. ⋯ Most women with an incomplete, spontaneous miscarriage chose expectant management and had a successful outcome. Neither the presence of a gestational sac, nor the endometrial thickness at diagnosis can be used to predict the likelihood of management failure. The current schedule of regular routine follow-up visits could be safely reduced to one or two fortnightly visits as appropriate, provided that patients have ready access to clinical advice by telephone.
-
Ultrasound Obstet Gynecol · May 2002
Teaching invasive perinatal procedures: assessment of a high fidelity simulator-based curriculum.
Learning curves pose a difficult problem in the teaching of technical skills: how do you teach procedural skills without compromising patients' health? A simulator-based curriculum has been designed to minimize the risks to patients undergoing amniocentesis by shifting the learning curve away from patients and into the laboratory. This study evaluated the effectiveness of a high-fidelity simulator-based curriculum in improving the performance of amniocentesis by obstetric trainees. ⋯ A comprehensive curriculum based on a high-fidelity simulator was effective at improving skills demonstrated on the simulator. The challenge remains to establish that skills acquired on a simulator are transferable to the clinical setting.
-
Ultrasound Obstet Gynecol · Mar 2002
Comparative StudyTeaching ultrasound-guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system.
To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system. ⋯ The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.
-
Ultrasound Obstet Gynecol · Nov 2001
Maternal diastolic function in asymptomatic pregnant women with bilateral notching of the uterine artery waveform at 24 weeks' gestation: a pilot study.
To study second-trimester maternal cardiac adaptation in asymptomatic patients at risk, on the basis of abnormal uterine artery Doppler, for the development of gestational hypertension or having a small-for-gestational age fetus. Fetal and maternal outcomes were verified at the end of pregnancy. ⋯ Women who subsequently develop a complication of pregnancy tend to display abnormal cardiac adaptation. An abnormal placentation process, expressed by an elevated resistance index and the presence of notches in the uterine artery waveform, are likely to cause an adaptative mechanism involving the whole cardiovascular system. A pathological outcome of pregnancy is associated with the failure of this process.
-
Ultrasound Obstet Gynecol · May 2001
Arterial Doppler ultrasound in 115 second- and third-trimester fetuses with congenital heart disease.
To assess the influence of isolated congenital heart disease (CHD) on fetal arterial Doppler blood flow velocity waveforms. ⋯ This study shows that arterial blood flow velocity waveforms in fetuses with isolated CHD do not show sufficient alterations to be of diagnostic value. Only in severe outflow tract obstructions due to a 'steal effect' or in significant insufficiencies of semilunar valves leading to an impaired 'wind-kessel function' may the special hemodynamic changes induced by CHD result in a significant increase of pulsatility index in the umbilical artery. In the majority of cases with CHD the increase of pulsatility index of umbilical arterial blood flow velocity waveforms, however, results from extracardiac anomalies, especially uteroplacental dysfunction and chromosomal abnormalities. Furthermore, umbilical artery Doppler sonography is not clinically helpful in predicting fetal outcome.