Ilan E Timor, M.D.

Term singleton pregnancy after conservative management of a complicated triplet gestation including a heterotopic cornual monochorionic twin pair
Bornstein, Eran; Berg, Robert; Santos, Rosalba; Monteagudo, Ana; Timor-Tritsch, Ilan E
2011 Jun;30(6):865-867, Journal of ultrasound in medicine
— id: 140491, year: 2011, vol: 30, page: 865, stat: Journal Article,

The utility of fetal echocardiography after an unremarkable anatomy scan
Friedman, Alexander M; Phoon, Colin K L; Fishman, Shira; Seubert, David E; Timor-Tritsch, Ilan E; Schwartz, Nadav
2011 Oct;118(4):921-927, Obstetrics & gynecology
OBJECTIVE: : To estimate whether fetal echocardiography detects major cardiac anomalies after normal anatomy ultrasound scan in patients at increased risk for having a fetus with congenital heart disease. METHODS: : A computerized database was used to identify patients who underwent fetal echocardiography at the New York University Division of Pediatric Cardiology after anatomy ultrasound scan at the New York University Obstetrics and Gynecology Ultrasound Unit. Only patients with normal anatomy ultrasound scan results were included in the primary analysis. Patients were excluded if they had suspicious cardiac views on anatomy ultrasound scan or extracardiac anomalies. Major cardiac anomalies were defined as those judged by a blinded pediatric cardiologist as likely to require medical or surgical intervention in the first 6 months of life. RESULTS: : Of 1,034 patients in the pediatric cardiology database, 536 patients underwent anatomy ultrasound scan at the New York University Obstetrics and Gynecology Department. Eighty patients in the case group were excluded for suspicious or inadequate cardiac views and 139 were excluded for extracardiac ultrasound findings. Of the remaining 317 patients with normal obstetric ultrasound scan results, none had a major cardiac malformation diagnosed on fetal echocardiography. CONCLUSION: : In a tertiary care center with operators performing a high volume of ultrasound screenings, fetal echocardiography after normal anatomy ultrasound scan may be of limited benefit. LEVEL OF EVIDENCE: : III
— id: 137852, year: 2011, vol: 118, page: 921, stat: Journal Article,

Prenatal diagnosis of unilateral proximal femoral focal deficiency at 19 weeks' gestation: case report and review of the literature
Mailath-Pokorny, M.; Timor-Tritsch, I. E.; Monteagudo, A.; Mittal, K.; Konno, F.; Santos, R.
2011 NOV ;38(5):594-597, Ultrasound in obstetrics & gynecology
Proximal femoral focal deficiency (PFFD) represents a rare and complex deformity manifested by hypoplasia of a variable portion of the femur with shortening of the entire limb. The condition may be unilateral or bilateral and is often associated with other congenital anomalies. Recent technological advances in ultrasound imaging offer the opportunity to detect an increasing number of rare skeletal malformation syndromes whose correct diagnosis is essential for adequate counseling and management of the pregnancy. We report a case of fetal non-familial PFFD diagnosed prenatally using two-dimensional and three-dimensional images. Clinical findings, differential diagnosis and management of this rare skeletal dysplasia are discussed and a review of the recent literature is given.
— id: 147726, year: 2011, vol: 38, page: 594, stat: Journal Article,

Placental Morphologic Features and Chorionic Surface Vasculature at Term Are Highly Correlated With 3-Dimensional Sonographic Measurements at 11 to 14 Weeks
Schwartz, Nadav; Mandel, Danielle; Shlakhter, Oleksandr; Coletta, Jaclyn; Pessel, Cara; Timor-Tritsch, Ilan E.; Salafia, Carolyn M.
2011 SEP ;30(9):1171-1178, Journal of ultrasound in medicine
Objectives-The purpose of this study was to examine the potential for 3-dimensional sonographic measurement of the early placenta in predicting ultimate placental morphologic features at delivery. Methods-In this prospective cohort study, we collected 3-dimensional sonographic volume sets of placentas at 11 to 14 weeks and then collected the placentas after delivery. The sonographic data were manipulated to obtain various novel measurements of early gross placental morphologic features and the umbilical cord insertion location. The placental weight, chorionic plate area, cord location, and mean chorionic vascular density were obtained from the delivered postpartum placentas. Analyses were performed to identify potential early placental characteristics that were correlated with the ultimate placental morphologic features. The placental weight, cord marginality, and mean chorionic vascular density served as the outcome measures of interest. Results-Measurements of the early placental volume correlated with the delivered placental weight. An irregular early placental shape, as measured by sonography, was significantly inversely correlated with placental weight (P < .05). The placental morphologic index, a measure of a flatter placenta, was inversely correlated with both the placental weight and chorionic plate area, possibly indicating the importance of placental thickness even in the first trimester before villous arborization. In addition, early sonographic measures of the location of the umbilical cord insertion were significantly correlated with the ultimate marginality of the cord insertion as well as the mean chorionic vascular density (P < .05). Conclusions-Many important ultimate placental morphologic features are likely predetermined early in pregnancy. Three-dimensional sonography may play an increasing role in the in utero evaluation of the early placenta
— id: 137811, year: 2011, vol: 30, page: 1171, stat: Journal Article,

Early biometric lag in the prediction of small for gestational age neonates and preeclampsia
Schwartz, Nadav; Pessel, Cara; Coletta, Jaclyn; Krieger, Abba M; Timor-Tritsch, Ilan E
2011 Jan;30(1):55-60, Journal of ultrasound in medicine
OBJECTIVE: An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. METHODS: In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (</=10th percentile) and preeclampsia. RESULTS: A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P < .05). The addition of either the estimated fetal weight or abdominal circumference lag to maternal characteristics alone significantly improved the performance of the predictive model, achieving areas under the curve of 0.72 and 0.74, respectively. No significant association was found between the biometric lag variables and the development of preeclampsia. CONCLUSIONS: Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes
— id: 134133, year: 2011, vol: 30, page: 55, stat: Journal Article,

"Richard Jaffe, MD, 1951-2010 In Memoriam"
Abramowicz, JS; Timor-Tritsch, IE
2010 JUL ;29(7):1150-1150, Journal of ultrasound in medicine
— id: 110853, year: 2010, vol: 29, page: 1150, stat: Journal Article,

Basic as well as detailed neurosonograms can be performed by offline analysis of three-dimensional fetal brain volumes
Bornstein, E; Monteagudo, A; Santos, R; Strock, I; Tsymbal, T; Lenchner, E; Timor-Tritsch, I E
2010 Jul;36(1):20-25, Ultrasound in obstetrics & gynecology
OBJECTIVES: To evaluate the feasibility and the processing time of offline analysis of three-dimensional (3D) brain volumes to perform a basic, as well as a detailed, targeted, fetal neurosonogram. METHODS: 3D fetal brain volumes were obtained in 103 consecutive healthy fetuses that underwent routine anatomical survey at 20-23 postmenstrual weeks. Transabdominal gray-scale and power Doppler volumes of the fetal brain were acquired by one of three experienced sonographers (an average of seven volumes per fetus). Acquisition was first attempted in the sagittal and coronal planes. When the fetal position did not enable easy and rapid access to these planes, axial acquisition at the level of the biparietal diameter was performed. Offline analysis of each volume was performed by two of the authors in a blinded manner. A systematic technique of 'volume manipulation' was used to identify a list of 25 brain dimensions/structures comprising a complete basic evaluation, intracranial biometry and a detailed targeted fetal neurosonogram. The feasibility and reproducibility of obtaining diagnostic-quality images of the different structures was evaluated, and processing times were recorded, by the two examiners. RESULTS: Diagnostic-quality visualization was feasible in all of the 25 structures, with an excellent visualization rate (85-100%) reported in 18 structures, a good visualization rate (69-97%) reported in five structures and a low visualization rate (38-54%) reported in two structures, by the two examiners. An average of 4.3 and 5.4 volumes were used to complete the examination by the two examiners, with a mean processing time of 7.2 and 8.8 minutes, respectively. The overall agreement rate for diagnostic visualization of the different brain structures between the two examiners was 89.9%, with a kappa coefficient of 0.5 (P < 0.001). CONCLUSIONS: In experienced hands, offline analysis of 3D brain volumes is a reproducible modality that can identify all structures necessary to complete both a basic and a detailed second-trimester fetal neurosonogram
— id: 110658, year: 2010, vol: 36, page: 20, stat: Journal Article,

A systematic technique using 3-dimensional ultrasound provides a simple and reproducible mode to evaluate the corpus callosum
Bornstein, Eran; Monteagudo, Ana; Santos, Rosalba; Keeler, Sean M; Timor-Tritsch, Ilan E
2010 Feb;202(2):201.e1-201.e5, American journal of obstetrics & gynecology
OBJECTIVE: The aim of this study was to evaluate a rapid 3-dimensional ultrasound-assisted technique for evaluation of the corpus callosum as an integral part of the anatomic survey. STUDY DESIGN: Transabdominal 3-dimensioal gray scale and power Doppler volumes of the fetal brain were acquired in 102 consecutive healthy fetuses at 20-23 postmenstrual weeks. Offline analysis was performed by 2 of the authors using a systematic approach of 'volume manipulation.' Diagnostic-quality visualization of the corpus callosum and the pericallosal arteries on the median plane was recorded by the 2 examiners independently. RESULTS: The median plane was easily obtained in all cases. Diagnostic-quality images of the corpus callosum were recorded in 93.1% and 99.0% and of the pericallosal arteries in 94.4% and 95.5% of the cases, by the 2 examiners, respectively. CONCLUSION: Three-dimensional ultrasound enables a rapid and easy evaluation of the corpus callosum that may facilitate its inclusion as an integral part of the routine anatomic survey
— id: 106496, year: 2010, vol: 202, page: 201.e1, stat: Journal Article,

Hemodynamic analysis of arterial blood flow in the coiled umbilical cord
Kaplan, Aaron D; Jaffa, Ariel J; Timor, Ilan E; Elad, David
2010 Mar;17(3):258-268, Reproductive sciences (Thousand Oaks, Calif.)
The most significant anatomical structure of the umbilical cord is its level of coiling. The coiled geometry of the umbilical cord largely affects umbilical blood flow that is vital for fetus's well-being and normal development. In this study, we developed a computational model of steady blood flow through the coiled structure of an umbilical artery. The results showed that the driving pressure for a given blood flow rate is increasing as the number of coils in cord structure increases. The driving gradient pressures also vary with the pitch that dictates the coils' spreading. The coiled structure is resulting in interwoven streamlines along the helix and wall shear stresses (WSS) with significant spatial gradients along the cross-sectional perimeter anywhere within the helical coil. These gradients may have an adverse effect on the development of the fetus cardiovascular system in cases with over coiling (OC) or under coiling (UC) characteristics. The number of coils does not affect the distribution and levels of WSS. However, when the coils are more spread (eg, larger pitch number), the maximal WSS is significantly smaller. Cases with twisted and OC cords seem to yield very large values and gradients of WSS, which may place the fetus into high risk of abnormal development
— id: 134367, year: 2010, vol: 17, page: 258, stat: Journal Article,

Diagnosis of pentalogy of cantrell using 2- and 3-dimensional sonography
Rodgers, Elizabeth B; Monteagudo, Ana; Santos, Rosalba; Greco, Alba; Timor-Tritsch, Ilan E
2010 Dec;29(12):1825-1828, Journal of ultrasound in medicine
— id: 114842, year: 2010, vol: 29, page: 1825, stat: Journal Article,

Novel 3-dimensional placental measurements in early pregnancy as predictors of adverse pregnancy outcomes
Schwartz, Nadav; Coletta, Jaclyn; Pessel, Cara; Feng, Rui; Timor-Tritsch, Ilan E; Parry, Samuel; Salafia, Carolyn N
2010 Aug;29(8):1203-1212, Journal of ultrasound in medicine
OBJECTIVE: We sought to determine whether novel approaches to volumetric assessment of the early placenta can yield significant predictors of adverse outcome. METHODS: We measured placental volume (PV) at 11 to 14 weeks using virtual organ computer-aided analysis and normalized the PV to the crown-rump length (CRL) to yield the placental quotient (PQ = PV/CRL). We also calculated the mean placental diameter (MPD) from 4 measurements taken at 45 degrees intervals to serve as a surrogate for the fetal-maternal surface area. On the fetal side, the distance from the cord insertion (CI) to the placental margin was measured every 45 degrees. Mean cord distance (MCD) is proposed as a novel descriptor of the chorionic plate and CI. Sonographic variables were analyzed as predictors of a composite adverse pregnancy outcome (COMP = small for gestational age [SGA], preeclampsia, spontaneous preterm birth, or neonatal intensive care unit admission). RESULTS: A total of 135 patients were included, and 40 (29.6%) had an adverse outcome. The mean PQ (P = .02) and MCD (P = .02) were significantly lower in patients with COMP, although MPD was not significantly different (P = .26). A PQ of less than 1.00 (relative risk [RR], 2.3 [95% confidence interval, 1.4-2.7]) and an MCD of less than 4.00 cm (RR, 1.8 [1.1-2.9]) conferred an increased risk for COMP. Prediction models adjusting for parity and race yielded favorable characteristics [PV: area under the curve [AUC], 0.796; P = .04; PQ: AUC, 0.802; P = .03; MCD: AUC, 0.800; P = .04; and MPD: AUC, 0.782; P = .07). Secondary models targeting SGA as the sole outcome also showed excellent prediction (PV: AUC, 0.820; PQ: AUC, 0.810; MCD: AUC, 0.827; and MPD: AUC, 0.795). CONCLUSIONS: In addition to volume, 3-dimensional sonography allows for novel techniques to measure other aspects of gross placental morphologic characteristics and CI, which can yield promising biologically plausible early predictors of fetal growth and adverse perinatal outcome
— id: 134356, year: 2010, vol: 29, page: 1203, stat: Journal Article,

Three-dimensional ultrasound inversion rendering technique facilitates the diagnosis of hydrosalpinx
Timor-Tritsch, Ilan E; Monteagudo, Ana; Tsymbal, Tanya
2010 Sep;38(7):372-376, Journal of clinical ultrasound
PURPOSE.: To test the utility of three-dimensional (3D) ultrasound (US) inversion rendering technique in the evaluation of fluid-distended fallopian tubes. METHODS.: Fifty-two patients with fluid-filled adnexal masses suspected of being abnormal fallopian tubes were scanned by two-dimensional and 3D transvaginal ultrasound (TVUS). Six patients had bilateral disease. The acquired volumes were then 'inverted' to display a cast-like appearance of the fluid-filled structures. The ipsilateral ovaries were identified in all patients. Five patients had acute tubal disease. RESULTS.: Fifty-two of the 58 inversion renderings yielded acceptable images of hydrosalpinges. Only in four patients were the two-dimensional images more informative than the 3D-rendered and inverted views. In nine patients adjacent corpora lutea, ovarian cysts, and follicles within normal ovaries were also identified, but appeared separate from the fluid-filled tubes. The tubes in the patients with acute disease were all successfully inverted. CONCLUSIONS.: The 3D inversion technique is a simple and effective way to render fluid-filled spaces, which may be tortuous and follow various directions. The rendered images increased the confidence in diagnosing hydrosalpinx. (c) 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:372-376, 2010
— id: 111586, year: 2010, vol: 38, page: 372, stat: Journal Article,

Role of second-trimester genetic sonography after Down syndrome screening
Aagaard-Tillery, Kjersti M; Malone, Fergal D; Nyberg, David A; Porter, T Flint; Cuckle, Howard S; Fuchs, Karin; Sullivan, Lisa; Comstock, Christine H; Saade, George R; Eddleman, Keith; Gross, Susan; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary E
2009 Dec;114(6):1189-1196, Obstetrics & gynecology
OBJECTIVE: To estimate the effectiveness of second-trimester genetic sonography in modifying Down syndrome screening test results. METHODS: The First and Second Trimester Evaluation of Risk (FASTER) aneuploidy screening trial participants were studied from 13 centers where a 15- to 23-week genetic sonogram was performed in the same center. Midtrimester Down syndrome risks were estimated for five screening test policies: first-trimester combined, second-trimester quadruple, and testing sequentially by integrated, stepwise, or contingent protocols. The maternal age-specific risk and the screening test risk were modified using likelihood ratios derived from the ultrasound findings. Separate likelihood ratios were obtained for the presence or absence of at least one major fetal structural malformation and for each 'soft' sonographic marker statistically significant at the P<.005 level. Detection and false-positive rate were calculated for the genetic sonogram alone and for each test before and after risk modification. RESULTS: A total of 7,842 pregnancies were studied, including 59 with Down syndrome. Major malformations and 8 of the 18 soft markers evaluated were highly significant. The detection rate for a 5% false-positive rate for the genetic sonogram alone was 69%; the detection rate increased from 81% to 90% with the combined test, from 81% to 90% with the quadruple test, from 93% to 98% with the integrated test, from 97% to 98% with the stepwise test, and from 95% to 97% with the contingent test. The stepwise and contingent use of the genetic sonogram after first-trimester screening both yielded a 90% detection rate. CONCLUSION: Genetic sonography can increase detection rates substantially for combined and quadruple tests and more modestly for sequential protocols. Substituting sonography for quadruple markers in sequential screening was not useful. LEVEL OF EVIDENCE: II
— id: 106604, year: 2009, vol: 114, page: 1189, stat: Journal Article,

Diagnostic and prognostic aspects in the sonographic evaluation of a fetus with an oral mass
Bornstein, Eran; Boozarjomehri, Fereshteh; Monteagudo, Ana; Santos, Rosalba; Milla, Sarah S; Timor-Tritsch, Ilan E
2009 May;28(5):689-693, Journal of ultrasound in medicine
— id: 100600, year: 2009, vol: 28, page: 689, stat: Journal Article,

"Brothers in arms": 3-dimensional sonographic findings in a first-trimester thoraco-omphalopagus conjoined twin pair
Bornstein, Eran; Santos, Rosalba; Timor-Tritsch, Ilan E; Monteagudo, Ana
2009 Jan;28(1):97-99, Journal of ultrasound in medicine
— id: 95514, year: 2009, vol: 28, page: 97, stat: Journal Article,

Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth A Cohort Study EDITORIAL COMMENT
Bukowski, R; Malone, FD; Porter, FT; Nyberg, DA; Comstock, CH; Hankins, GDV; Eddleman, K; Gross, SJ; Dugoff, L; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2009 OCT ;64(10):635-636, Obstetrical & gynecological survey
A number of studies have reported an association between low concentrations of serum folate and preterm birth. Folate supplementation during pregnancy increased the length of pregnancy in some but not all clinical trials. This cohort study investigated whether preconceptional folate supplementation (as ascertained by patient questionnaire in the first trimester of pregnancy) lowers the risk of spontaneous preterm birth. The investigators analyzed data collected from a cohort of 34,480 low-risk singleton pregnancies in women enrolled in a previous prospective cohort study on Down syndrome screening conducted at 15 US centers between 1999 and 2002. Duration of pregnancy was estimated by ultrasound measurement in the first trimester. Spontaneous preterm birth was defined as preterm birth between 20 and 37 weeks with no medical or obstetrical complications that constituted indications for delivery. The effects of the duration of preconceptional folate supplementation of <= 1 year (long-term), <1 year and the effect of no supplementation on risk of spontaneous preterm birth were compared using time-to-event analysis. Data were subjected to analysis with multivariable logistic regression. Compared to women who did not take a folate supplement, the risk of spontaneous preterm delivery between 20 and 28 weeks was 70% lower in women who took folate supplements for a year or longer before pregnancy (0.27% vs 0.04%); the hazard ratio was 0.22, with a 95% confidence interval of 0.08 to 0.61, P = 0.004. Long-term folate supplementation reduced the risk between 28 and 32 weeks by over 50% (0.38% vs 0.18%) (hazard ratio, 0.45; 95% confidence interval, 0.24-0.83, P = 0.010). Supplementation had no significant effect on the risk of spontaneous preterm birth beyond 32 weeks. Adjustment for maternal variables (age, body mass index, race and ethnicity, educational level, marital status, smoking, parity and history of prior preterm birth) did not affect the association between long-term folate and risk of spontaneous preterm birth but did eliminate the association found in unadjusted analysis between duration of preconceptional folate supplementation less than one year and risk. These findings suggest that preconceptional folate supplementation for a year or longer may substantially reduce the risk of early spontaneous preterm birth. The risk is lower with longer duration of folate supplementation before pregnancy. The beneficial effect of folic acid does not appear to be associated with other complications of pregnancy such as preeclampsia, small for gestational age infant, placental abruption, or nonspontaneous preterm birth
— id: 104878, year: 2009, vol: 64, page: 635, stat: Journal Article,

Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study
Bukowski, Radek; Malone, Fergal D; Porter, Flint T; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Eddleman, Keith; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2009 May 5;6(5):e1000061-e1000061, PLoS medicine
BACKGROUND: Low plasma folate concentrations in pregnancy are associated with preterm birth. Here we show an association between preconceptional folate supplementation and the risk of spontaneous preterm birth. METHODS AND FINDINGS: In a cohort of 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester of pregnancy. Duration of pregnancy was estimated based on first trimester ultrasound examination. Natural length of pregnancy was defined as gestational age at delivery in pregnancies with no medical or obstetrical complications that may have constituted an indication for delivery. Spontaneous preterm birth was defined as duration of pregnancy between 20 and 37 wk without those complications. The association between preconceptional folate supplementation and the risk of spontaneous preterm birth was evaluated using survival analysis. Comparing to no supplementation, preconceptional folate supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk (41 [0.27%] versus 4 [0.04%] spontaneous preterm births, respectively; HR 0.22, 95% confidence interval [CI] 0.08-0.61, p = 0.004) and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk (58 [0.38%] versus 12 [0.18%] preterm birth, respectively; HR 0.45, 95% CI 0.24-0.83, p = 0.010). Adjustment for maternal characteristics age, race, body mass index, education, marital status, smoking, parity, and history of prior preterm birth did not have a material effect on the association between folate supplementation for 1 y or longer and spontaneous preterm birth between 20 and 28, and 28 to 32 wk (adjusted HR 0.31, 95% CI 0.11-0.90, p = 0.031 and 0.53, 0.28-0.99, p = 0.046, respectively). Preconceptional folate supplementation was not significantly associated with the risk of spontaneous preterm birth beyond 32 wk. The association between shorter duration (<1 y) of preconceptional folate supplementation and the risk of spontaneous preterm birth was not significant after adjustment for maternal characteristics. However, the risk of spontaneous preterm birth decreased with the duration of preconceptional folate supplementation (test for trend of survivor functions, p = 0.01) and was the lowest in women who used folate supplementation for 1 y or longer. There was also no significant association with other complications of pregnancy studied after adjustment for maternal characteristics. CONCLUSIONS: Preconceptional folate supplementation is associated with a 50%-70% reduction in the incidence of early spontaneous preterm birth. The risk of early spontaneous preterm birth is inversely proportional to the duration of preconceptional folate supplementation. Preconceptional folate supplementation was specifically related to early spontaneous preterm birth and not associated with other complications of pregnancy
— id: 106440, year: 2009, vol: 6, page: e1000061, stat: Journal Article,

Challenges and Pitfalls in the Diagnosis of Ectopic Pregnancy: Multimodality Imaging Evaluation (CME Credit Available)
Chaudhri, Y; Mauch, E; Oto, A; Slywotzky, C; Timor-Tritsch, I; Bennett, G
2009 MAY ;192(5):646-651, American journal of roentgenology
— id: 99183, year: 2009, vol: 192, page: 646, stat: Journal Article,

Antenatal treatment of fetal goiter: a therapeutic challenge
Hanono, Anat; Shah, Bina; David, Raphael; Buterman, Irving; Roshan, Daniel; Shah, Shetal; Lam, Leslie; Timor-Tritsch, Ilan
2009 Jan;22(1):76-80, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: Pre-natal ultrasonography presents an opportunity for in-utero therapy of a fetal goiter. Because of the morbidity associated with a large goiter and the risks of repeated intra-amniotic injections, controversy arose about the precise indications of this mode of treatment. We describe our observations in treating a 22-week-old fetus with a large goiter because of dyshormogenesis, monitored with serial 3D high frequency, high resolution ultrasonography and amniotic hormonal measurements. Fetal hypothyroidism was confirmed by cordocentesis and amniotic hormone levels. After assessment of relevant risk factors and the criteria for in-utero intervention, including goiter volume, amniotic fluid index, polyhydramnios and tracheal compression, we determined that hormonal therapy was warranted. Levothyroxine was injected every 7-10 days, and its efficacy monitored by ultrasound changes and amniotic hormone sampling. RESULTS: Reduction in goiter volume restored normal neck flexion relieving the pressure on the trachea, polyhydramnios was prevented and amniotic hormone levels were normalised. The infant was euthyroid at birth, however, by age 4 days hypothyroidism was diagnosed, and treatment with l-thyroxine started. CONCLUSION: Advances in fetal ultrasonography permit judicious therapy of an enlarging goiter in a hypothyroid fetus, which may contribute to enhancing cognitive development. We discuss the value of amniotic hormone sampling, the objectives and risks of in-utero intervention in the light of recent literature and our own observations
— id: 96296, year: 2009, vol: 22, page: 76, stat: Journal Article,

Three-dimensional power Doppler angiography of cyclic ovarian blood flow
Hope, Joanie Mayer; Long, Kara; Kudla, Marek; Arslan, Alan; Tsymbal, Tatiana; Strok, Irina; Timor-Tritsch, Ilan E
2009 Aug;28(8):1043-1052, Journal of ultrasound in medicine
OBJECTIVE: The purpose of this study was to assess the vascular indices generated by 3-dimensional (3D) power Doppler angiography by evaluating the cyclic changes in the vascularity of normal ovaries, including those that were ovulating, nonovulating, and hormonally suppressed. METHODS: In this prospective longitudinal observational study, a cohort of premenopausal regularly menstruating women with no known ovarian disease underwent 3D power Doppler imaging every 2 to 3 days for the duration of 1 menstrual cycle. Four indices were generated: vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and mean grayness. Comparisons of vascularity were made between ovulating, nonovulating, and hormonally suppressed ovaries. Normal ranges were established and graphed longitudinally. RESULTS: Eighteen participants (36 ovaries) ages 28 to 45 years underwent an average of 10 examinations, yielding 368 acquired ovarian volumes for analysis. Seven participants used hormonal contraception. The VI, FI, and VFI were closely correlated (Pearson product moment correlation coefficients, 0.52-0.95). The vascular indices of ovulating ovaries were significantly higher than those of nonovulating ovaries (VI, FI, and VFI, all P < .001), with the largest discrepancies during the luteal phase. Hormonally suppressed ovaries had significantly lower vascularity throughout the cycle (VI, P < .002; FI, P < .001; VFI, P < .007). The vascular indices of all groups appeared to drop during the late follicular period and then rise again. CONCLUSIONS: The VI would suffice as the principal vascular parameter for 3D power Doppler analysis. Preovulatory scans may be more useful for distinguishing pathologic vascularization. Hormonally suppressed ovaries have significantly lower vascularity throughout the cycle. Normal-appearing ovaries with vascular indices above the normal ranges established by these data may warrant further investigation
— id: 101324, year: 2009, vol: 28, page: 1043, stat: Journal Article,

Tubal assessment and disease
Keeler S.M.; Proudfit C.; Timor-Tritsch I.E.
2009 ;4(3):331-344, Expert review of obstetrics & gynecology
Imaging the fallopian tube with transvaginal sonography is a daunting task for any sonologist. High-frequency ultrasound transducers, the advancement of color and power Doppler, as well as 3D surface rendering, have advanced the assessment of fallopian tubes in healthy and pathologic states. This review focuses on fallopian tube anatomy, imaging modalities available for its assessment and common pathologic processes, including infection/inflammation, ectopic pregnancy, salpingitis isthmica nodosum, tubal torsion and prolapse, and fallopian tube carcinoma. The natural history of pelvic inflammatory disease is discussed in detail with a sonographic representation of the disease process. 2009 Expert Reviews Ltd
— id: 123215, year: 2009, vol: 4, page: 331, stat: Journal Article,

Normal sonographic development of the central nervous system from the second trimester onwards using 2D, 3D and transvaginal sonography
Monteagudo, Ana; Timor-Tritsch, Ilan E
2009 Apr;29(4):326-339, Prenatal diagnosis
The developmental changes of the fetal central nervous system (CNS) during the second and third trimesters, specifically the brain, relate mostly to changes in size. However, other changes do occur in the fetal brain during the second and third trimester such as: the union of the cerebellar hemispheres, development of the corpus callosum (CC), and increasing complexity of the cerebral cortex. These changes follow a well-defined developmental timeline recognizable by sonography.The fetal neuroscan can be divided into a 'basic scan' which is performed transabdominally and a 'targeted Exam or neurosonogram' which uses a multiplanar approach, which preferably should be performed transvaginally. During the 'basic scan', several brain structures are imaged in addition to obtaining important biometric measurements. The 'neurosonogram' is a more extensive or detailed fetal study during which the emphasis is on the addition of coronal and sagittal planes. The easiest way to obtain these planes, if the fetus is in a cephalic presentation, is the transvaginal route. Three-dimensional (3D) sonography should, if possible, be performed transvaginally using the multiplanar approach. An added benefit of 3D sonography is the ability to display and render the volume in a variety of ways which may enhance the detection of pathology.
— id: 95515, year: 2009, vol: 29, page: 326, stat: Journal Article,

Adnexal Masses in Pregnancy
Schwartz, N; Timor-Tritsch, IE; Wang, E
2009 DEC ;52(4):570-585, Clinical obstetrics & gynecology
With the increased use and quality of ultrasound in pregnancy, adenxal masses are being encountered with greater frequency. Fortunately, most of such masses are benign and resolve on their own. However, complications such as ovarian torsion can occur. In addition, a malignancy can be present in a small minority of cases. In this article, we review the available literature on this subject to help guide the clinician in the diagnosis and management of adnexal masses in pregnancy
— id: 105374, year: 2009, vol: 52, page: 570, stat: Journal Article,

Neurosonography to detect brain injury in a surviving monochorionic twin after demise of its co-twin
Schwartz, Nadav; Keeler, Sean M; Fishman, Shira; Timor-Tritsch, Ilan E
2009 Mar-Apr;37(3):165-167, Journal of clinical ultrasound
— id: 106034, year: 2009, vol: 37, page: 165, stat: Journal Article,

Prenatal sonographic findings of an isolated cervical esophageal duplication cyst
Sherer, David M; Timor-Tritsch, Ilan E; Dalloul, Mudar; Zinn, Harry; Sokolovski, Margarita; Kheyman, Mila; Yu, Sarah; Abulafia, Ovadia
2009 Mar;28(3):405-407, Journal of ultrasound in medicine
— id: 133690, year: 2009, vol: 28, page: 405, stat: Journal Article,

Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography
Timor-Tritsch, Ilan E
2009 Nov;114(5):1145-1145, Obstetrics & gynecology
— id: 107382, year: 2009, vol: 114, page: 1145, stat: Journal Article,

Performing a fetal anatomy scan at the time of first-trimester screening
Timor-Tritsch, Ilan E; Fuchs, Karin M; Monteagudo, Ana; D'alton, Mary E
2009 Feb;113(2 Pt 1):402-407, Obstetrics & gynecology
Over the past decade, prenatal diagnosis has shifted rapidly from the second trimester into the first trimester. Although the nuchal-translucency scan may detect a small proportion of fetal structural malformations, fetal anatomy is not routinely assessed until the fetal anatomical survey is performed in the second trimester between 18 and 22 weeks. The recent development of high-frequency transvaginal ultrasound transducers has led to vastly improved ultrasound resolution and improved visualization of fetal anatomy earlier in gestation. Several pilot studies of a first-trimester anatomic survey have reported detection rates comparable with those achieved in the routine second-trimester anatomic survey. As advanced ultrasound technology becomes more available, there is an urgent need to evaluate the diagnostic ability of a first-trimester anatomic survey and to determine the role of a first-trimester anatomic survey in the current screening paradigm
— id: 93227, year: 2009, vol: 113, page: 402, stat: Journal Article,

Greig cephalopolysyndactyly syndrome: diagnosis based on prenatal sonographic features coupled with comparative genomic hybridization
Timor-Tritsch, Ilan E; Kapp, Sarah; Berg, Robert; Bejjani, Bassem A; Adams, Sara Anne; Monteagudo, Ana; Divon, Michael; Pappas, John G
2009 Dec;28(12):1735-1742, Journal of ultrasound in medicine
— id: 105513, year: 2009, vol: 28, page: 1735, stat: Journal Article,

Prenatal sonographic diagnosis of a buried penis
Timor-Tritsch, Ilan E; Shapiro, Ellen; Patrick, Sharon L; Monteagudo, Ana
2009 Oct;28(10):1389-1392, Journal of ultrasound in medicine
— id: 102937, year: 2009, vol: 28, page: 1389, stat: Journal Article,

3D and 4D Fetal Neuroscan: Sharing the Know-how and Tricks of the Trade
Bornstein E.; Monteagudo A.; Timor-Tritsch I.E.
2008 ;3(4):517-528, Ultrasound Clinics
Visual information from 2-D images may be limited in reflecting a 3-D structural reality. 3-D techniques have emerged enabling acquisition of an entire volume of spatial ultrasound information that can be analyzed and displayed in multiple planes and display modes that exceed the capacities of 2-D US and better reflect the 3-D nature of a structure or anomaly. In the future 3-D evaluation of the fetal body will be an inherent part of fetal study in cases of congenital anomaly' specifically fetal brain abnormality. This article focuses on the technique for obtaining and analyzing acquired volumes and displaying them. copyright 2008 Elsevier Inc. All rights reserved
— id: 97996, year: 2008, vol: 3, page: 517, stat: Journal Article,

The Utilization of 3D and 4D Technology in Fetal Neurosonology
Bornstein E.; Monteagudo A.; Timor-Tritsch I.E.
2008 ;3(4):489-516, Ultrasound Clinics
This article discusses the clinical use of three-dimensional technology while performing a fetal neuroscan. This technique allows us to better define the spatial relationship of brain structures and possible malformations. The varieties of display modes and the infinite number of different planes that can be generated facilitate the diagnostic process. Additional values of this technology include an off-line analysis of the volume by the sonographer or sonologist to obtain the necessary planes, as well as an electronic transmittal for an off-site expert to provide a second opinion consultation. This modality requires a short acquisition time, allowing high patient through-put and increased patient satisfaction. In addition, it is an excellent teaching tool and provides valuable information to consulting such experts as pediatric surgeons, plastic surgeons, neonatologists, neurologists and neurosurgeons. copyright 2008 Elsevier Inc. All rights reserved
— id: 97869, year: 2008, vol: 3, page: 489, stat: Journal Article,

A SYSTEMATIC TECHNIQUE USING 3D ULTRASOUND PROVIDES A SIMPLE AND RELIABLE MODE TO EVALUATE THE CORPUS CALLOSUM
Bornstein, E; Monteagudo, A; Santos, R; Keeler, S; Timor-Tritcsh, IE
2008 DEC ;199(6):S124-S124, American journal of obstetrics & gynecology
— id: 91866, year: 2008, vol: 199, page: S124, stat: Journal Article,

Severe uropathy and normal amniotic fluid volume in a male fetus: sonographic surveillance leading to the diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome
Bornstein, Eran; Atkins, Kristin; Fishman, Shira; Monteagudo, Ana; Bajor-Dattilo, Ewa B; Arif, Farzana; Monda, Susan; Greco, Alba M; Timor-Tritsch, Ilan E
2008 Jul;27(7):1099-1104, Journal of ultrasound in medicine
The widespread use of sonography as a screening tool for fetal anomalies has facilitated prenatal detection of several fetal conditions characterized by urinary tract dilatation. These conditions are more common in male fetuses and are generally a result of an anatomic defect causing obstruction along the urinary tract system. Although the prognosis of these conditions largely depends on the specific anomaly, several poor prognostic factors have been described. These factors include detection at an early gestational age, bilateral marked dilatation, a persistently obstructed bladder, oligohydramnios causing pulmonary hypoplasia, and the presence of associated fetal or chromosomal anomalies. We report a case in which a male fetus at 14 weeks' gestation had a diagnosis of rapidly progressing bilateral hydronephrosis, massive bladder dilatation, hydroureter, and a surprisingly normal amniotic fluid volume. Serial sonographic surveillance assisted us in obtaining the correct diagnosis, which was important for adequately consulting the patient regarding the fetal prognosis in the affected index pregnancy as well as the likelihood of recurrence in future gestations
— id: 91431, year: 2008, vol: 27, page: 1099, stat: Journal Article,

Detection of twin reversed arterial perfusion sequence at the time of first-trimester screening: the added value of 3-dimensional volume and color Doppler sonography
Bornstein, Eran; Monteagudo, Ana; Dong, Ran; Schwartz, Nadav; Timor-Tritsch, Ilan E
2008 Jul;27(7):1105-1109, Journal of ultrasound in medicine
Twin reversed arterial perfusion (TRAP) sequence, also known as acardiac malformation, is a rare complication unique to monozygotic multiple gestations. It occurs in approximately 1 per 35,000 pregnancies and in 0.3% of all monozygotic twin gestations. The malformation is characterized by the lack of a well-defined cardiac structure in one twin (acardiac), which acts as a parasite that is hemodynamically dependent on the normal (pump) twin. The malformation in the acardiac twin is always incompatible with survival regardless of its extent, whereas the prognosis of the pump twin may vary considerably. Common complications that affect the prognosis of the pump twin include complications of prematurity secondary to preterm delivery and polyhydramnios as well as congestive heart failure due to the expended cardiac demand. Without prompt detection, follow-up, and treatment, mortality rates for pump twins have been noted to be as high as 50% to 70%. Early sonographic diagnosis, appropriate follow-up, and intervention via cord occlusion when indicated are the mainstays of prenatal care in cases of TRAP sequence and have been associated with substantial improvements in survival. We report a case that emphasizes the added value of 3-dimensional (3D) and color Doppler techniques for both diagnosis of TRAP sequence and detection of poor prognostic features in the first or early second trimester
— id: 91432, year: 2008, vol: 27, page: 1105, stat: Journal Article,

Sonographic detection of fetal rectal prolapse: an unfinished symphony
Bornstein, Eran; Monteagudo, Ana; Keeler, Sean; Timor-Tritsch, Ilan E
2008 Apr;27(4):677-679, Journal of ultrasound in medicine
— id: 76474, year: 2008, vol: 27, page: 677, stat: Journal Article,

FETAL MACROSOMIA INCREASES RISK OF STILLBIRTH
Bukowski, R; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Hankins, G; Eddleman, K; Gross, SJ; Dugoff, L; Craigo, S; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2008 DEC ;199(6):S93-S93, American journal of obstetrics & gynecology
— id: 91864, year: 2008, vol: 199, page: S93, stat: Journal Article,

PRECONCEPTIONAL FOLATE REDUCES PERINATAL MORTALITY AND MORBIDITY
Bukowski, R; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Hankins, G; Eddleman, K; Gross, SJ; Dugoff, L; Craigo, S; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2008 DEC ;199(6):S94-S94, American journal of obstetrics & gynecology
— id: 91865, year: 2008, vol: 199, page: S94, stat: Journal Article,

Individualized norms of optimal fetal growth: fetal growth potential
Bukowski, Radek; Uchida, Tatsuo; Smith, Gordon C S; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2008 May;111(5):1065-1076, Obstetrics & gynecology
OBJECTIVE: To demonstrate that individualized optimal fetal growth norms, accounting for physiologic and pathologic determinants of fetal growth, better identify normal and abnormal outcomes of pregnancy than existing methods. METHODS: In a prospective cohort of 38,033 singleton pregnancies, we identified 9,818 women with a completely normal outcome of pregnancy and characterized the physiologic factors affecting birth weight using multivariable regression. We used those physiologic factors to individually predict optimal growth trajectory and its variation, growth potential, for each fetus in the entire cohort. By comparing actual birth weight with growth potential, population, ultrasound, and customized norms, we calculated for each fetus achieved percentiles, by each norm. We then compared proportions of pregnancies classified as normally grown, between 10th and 90th percentile, or aberrantly grown, outside this interval, by growth potential and traditional norms, in 14,229 complicated pregnancies, 1,518 pregnancies with diabetes or hypertensive disorders, and 1,347 pregnancies with neonatal complications. RESULTS: Nineteen physiologic factors, associated with maternal characteristics and early placental function, were identified. Growth potential norms correctly classified significantly more pregnancies than population, ultrasound, or customized norms in complicated pregnancies (26.4% compared with 18.3%, 18.7%, 22.8%, respectively, all P<.05), pregnancies with diabetes or hypertensive disorders (37.3% compared with 23.0%, 28.0%, 34.0%, respectively, all P<.05) and neonatal complications (33.3% compared with 19.7%, 24.9%, 29.8%, respectively, all P<.05). CONCLUSION: Growth potential norms based on the physiologic determinants of birth weight are a better discriminator of aberrations of fetal growth than traditional norms. LEVEL OF EVIDENCE: II
— id: 95016, year: 2008, vol: 111, page: 1065, stat: Journal Article,

Contingent screening for Down syndrome--results from the FaSTER trial
Cuckle, Howard S; Malone, Fergal D; Wright, David; Porter, T Flint; Nyberg, David A; Comstock, Christine H; Saade, George R; Berkowitz, Richard L; Ferreira, Jose C; Dugoff, Lorraine; Craigo, Sabrina D; Timor, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2008 Feb;28(2):89-94, Prenatal diagnosis
OBJECTIVE: Comparison of contingent, step-wise and integrated screening policies. METHODS: Mid-trimester Down syndrome risks were retrospectively calculated from FaSTER trial data. For contingent screening, initial risk was calculated from ultrasound measurement of nuchal translucency (NT), maternal serum pregnancy-associated plasma protein (PAPP)-A and free beta-human chorionic gonadotrophin (hCG) at 11-13 weeks, and classified positive (>1 in 30), borderline (1 in 30-1500) or negative. Borderline risks were recalculated using alpha-fetoprotein, hCG, unconjugated estriol (uE3) and inhibin at 15-18 weeks, and reclassified as positive (>1 in 270) or negative. For step-wise screening, initial negative risks were also recalculated. For integrated screening, a single risk was calculated from NT, PAPP-A and the second trimester markers. RESULTS: There were 86 Down syndrome and 32,269 unaffected pregancies. The detection rate for contingent screening was 91% and false-positive rate was 4.5%; initial detection rate was 60%, initial false-positive rate was 1.2% and borderline risk was 23%. Step-wise screening had 92% detection rate and 5.1% false-positive rate; integrated screening had 88% and 4.9% respectively. CONCLUSION: As predicted by modelling, the contingent screening detection rate for a fixed false-positive rate is comparable with step-wise and integrated screening, but substantially reduces the number needing to return for second trimester testing
— id: 95017, year: 2008, vol: 28, page: 89, stat: Journal Article,

Contingent screening for Down syndrome
Cuckle, HS; Malone, FD; Wright, D; Porter, TF; Nyberg, DA; Comstock, CH; Saade, GR; Berkowitz, RL; Ferreira, JC; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2008 AUG ;28(8):782-782, Prenatal diagnosis
— id: 86805, year: 2008, vol: 28, page: 782, stat: Journal Article,

Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers
Dugoff, L; Cuckle, HS; Hobbins, JC; Malone, FD; Belfort, MA; Nyberg, DA; Comstock, CH; Saade, GR; Eddleman, KA; Dar, P; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2008 SEP ;199(3):1333-1339, American journal of obstetrics & gynecology
OBJECTI
— id: 86594, year: 2008, vol: 199, page: 1333, stat: Journal Article,

Down syndrome serum screening also identifies an increased risk for multicystic dysplastic kidney, two-vessel cord, and hydrocele
Hoffman, JD; Bianchi, DW; Sullivan, LM; Mackinnon, BL; Collins, J; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Bukowski, R; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2008 DEC ;28(13):1204-1208, Prenatal diagnosis
Objective The FASTER trial compared first and second trimester screening methods for aneuploidy. We examined relationships between maternal serum markers and common congenital anomalies in the pediatric Outcome data set of 36 837 subjects. Methods We used nested case-control Studies, with cases defined by the most common anomalies in our follow-up database, and up to four controls matched by enrollment site, maternal age and race, enrollment gestational age, and infant gender. Serum markers were dichotomized to >= 2 or <0.5 multiples of the median (MoM). Odds ratios (ORs) and 95% confidence intervals (CI) were estimated. Results Statistically significant (p < 0.05) associations were found between inhibin A >= 2 MoM with fetal multicystic dysplastic kidney (MCDK) (OR = 27.5, 95%
— id: 91855, year: 2008, vol: 28, page: 1204, stat: Journal Article,

Spherical tissue sampling in 3-dimensional power Doppler angiography: a new approach for evaluation of ovarian tumors
Kudla, Marek J; Timor-Tritsch, Ilan E; Hope, Joanie Mayer; Monteagudo, Ana; Popiolek, Dorota; Monda, Susan; Lee, Catherine J; Arslan, Alan A
2008 Mar;27(3):425-433, Journal of ultrasound in medicine
OBJECTIVE: The purpose of this study was to evaluate the usefulness of virtual spherical tissue sampling using 3-dimensional (3D) ultrasound power Doppler angiography to enhance differentiation between normal and pathologic ovaries. METHODS: Twenty-seven cases with ovarian tumors were analyzed: 14 with invasive cancers and 13 with borderline tumors confirmed by surgery. The control subjects consisted of 53 healthy ovulating women. Ultrasound scans were done, and 3D volumes were analyzed with 3-/4-dimensional software for personal computers based on 3D vascularity indices: the vascularization index, flow index, and vascularization-flow index. A virtual spherical tissue sample of 1 cm(3) was taken from the place of the highest vessel density contained completely within the contours of the ovary. Calculations for the whole solid volume were done for comparison. RESULTS: Vascularity indices for both 1-cm(3) spherical samples and whole dense parts of the ovaries were compared in the following groups: (1) ovarian tumors versus controls, (2) normal ovaries in the proliferative versus secretory phase, (3) invasive cancers versus borderline tumors, (4) invasive cancers versus normal ovaries, and (5) borderline tumors versus normal ovaries. Spherical 1-cm(3) sampling achieved a higher degree of discrimination between the groups compared with the whole solid-part approach. CONCLUSIONS: Spherical 1-cm(3) sampling of ovarian tissue with 3D ultrasound power Doppler angiography is a sensitive and promising approach to differentiate between ovarian tumors and normal ovaries. It opens the possibility to implement objective computerized positioning, standardized comparison, and analysis of ovarian tumors
— id: 76475, year: 2008, vol: 27, page: 425, stat: Journal Article,

The Utility of Volume Sonography for the Detection of Fetal Spine Abnormalities
Lazebnik N.; Bornstein E.; Timor-Tritsch I.E.
2008 ;3(4):529-539, Ultrasound Clinics
Sonographic evaluation of the fetal vertebral column is essential for fetal central nervous system evaluation and valuable for ruling out genetic conditions. This article provides an overview for obtaining and manipulating fetal vertebrae three-dimensional data as to obtain the necessary diagnostic views. Additional technical information is provided elsewhere in this issue. This discussion is limited to include only the most common fetal vertebral abnormalities. The same technical principals, however, enable detection of many additional abnormalities. copyright 2008 Elsevier Inc. All rights reserved
— id: 97868, year: 2008, vol: 3, page: 529, stat: Journal Article,

Postpartum management of placenta previa accreta left in situ: role of 3-dimensional angiography
Most, Orli Langer; Singer, Tomer; Buterman, Irving; Monteagudo, Ana; Timor-Tritsch, Ilan E
2008 Sep;27(9):1375-1380, Journal of ultrasound in medicine
— id: 93356, year: 2008, vol: 27, page: 1375, stat: Journal Article,

Thrombosis of an ectatic torcular herophili: anatomic localization using fetal neurosonography
Schwartz, Nadav; Monteagudo, Ana; Bornstein, Eran; Timor-Tritsch, Ilan E; Zagzag, David; Kudla, Marek
2008 Jun;27(6):989-991, Journal of ultrasound in medicine
— id: 92912, year: 2008, vol: 27, page: 989, stat: Journal Article,

Transvaginal fetal neuroscan
Schwartz, Nadav; Timor-Tritsch, Ilan E; Monteagudo, Ana
Fetal and neonatal neurology and neurosurgery New York NY : Churchill Livingstone/Elsevier, 2008,
— id: 5247, year: 2008, vol: , page: ?, stat: Chapter,

Three-dimensional inversion rendering in the first- and early second-trimester fetal brain: its use in holoprosencephaly
Timor-Tritsch, I E; Monteagudo, A; Santos, R
2008 Nov;32(6):744-750, Ultrasound in obstetrics & gynecology
OBJECTIVES: To explore the feasibility and added value of three-dimensional (3D) inversion rendering of the developing embryonic/fetal ventricular system, and to apply this display technique to enhance the sonographic examination of holoprosencephaly. METHODS: 3D volumes of the embryonic/fetal brain were acquired from four normal fetuses at 8-11 postmenstrual weeks, and four fetuses diagnosed with holoprosencephaly between 9 and 14 postmenstrual weeks. The volumes were then analyzed offline to obtain inversion rendered 3D shapes of the ventricular systems. RESULTS: All inversion rendering displays were successful and provided the opportunity to study normal as well as pathological aspects of the early fetal brain. CONCLUSIONS: Inversion rendering of early fetal brain ventricles is feasible and should be attempted if additional information about the early normal or pathological fetal brain is needed. It may have scientific value in embryologic or genetic studies
— id: 99584, year: 2008, vol: 32, page: 744, stat: Journal Article,

Fine-tuning the diagnosis of fetal scalp cysts: the value of high-frequency sonography
Timor-Tritsch, Ilan E; Monteagudo, Ana; Santos, Rosalba
2008 Sep;27(9):1363-1368, Journal of ultrasound in medicine
OBJECTIVE: The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence. METHODS: Transabdominal and transvaginal 2- and 3-dimensional sonography with color and power Doppler imaging as well as 3-dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed. RESULTS: In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst. CONCLUSIONS: These 2 cases show the value of going the distance with the newly available high-frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality
— id: 93355, year: 2008, vol: 27, page: 1363, stat: Journal Article,

Metastatic gestational trophoblastic disease following a complete hydatidiform mole coexistent with an anencephalic fetus diagnosed at 10 weeks' gestation
Wagner, Sarah A; Keeler, Sean M; Blank, Stephanie V; Timor-Tritsch, Ilan E
2008 Oct;27(10):1533-1536, Journal of ultrasound in medicine
— id: 91444, year: 2008, vol: 27, page: 1533, stat: Journal Article,

First- and second-trimester evaluation of risk for Down syndrome
Ball, Robert H; Caughey, Aaron B; Malone, Fergal D; Nyberg, David A; Comstock, Christine H; Saade, George R; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Emig, Danielle; D'Alton, Mary E
2007 Jul;110(1):10-17, Obstetrics & gynecology
OBJECTIVE: To investigate the differences in costs and outcomes of Down syndrome screening using data from the First and Second Trimester Evaluation of Risk (FASTER) Trial. METHODS: Seven possible screening options for Down syndrome were compared: 1) Triple Screen-maternal serum alpha fetoprotein, estriol, and hCG; 2) Quad-maternal serum alpha fetoprotein, estriol, hCG, and Inhibin A; 3) Combined First-nuchal translucency, pregnancy-associated plasma protein A (PAPP-A), free beta-hCG; 4) Integrated-nuchal translucency, PAPP-A, plus Quad; 5) Serum Integrated-PAPP-A, plus Quad; 6) Stepwise Sequential-Combined First plus Quad with results given after each test; and 7) Contingent Sequential-Combined First and only those with risk between 1:30 and 1:1,500 have Quad screen. The detection rates for each option were used given a 5% false-positive rate except for Contingent Sequential with a 4.3% false-positive rate. Outcomes included societal costs of each screening regimen (screening tests, amniocentesis, management of complications, and cost of care of Down syndrome live births), Down syndrome fetuses identified and born, the associated quality-adjusted life years, and the incremental cost-utility ratio. RESULTS: Based on the screening results derived from the 38,033 women evaluated in the FASTER trial, the Contingent Sequential screen dominated (lower costs with better outcomes) all other screens. For example, the Contingent Sequential cost 32.3 million dollars whereas the other screens ranged from 32.8 to 37.5 million dollars. The Sequential strategy led to the identification of the most Down syndrome fetuses of all of the screens, but at a higher cost per Down syndrome case diagnosed ($719,675 compared with $690,427) as compared with the Contingent Sequential. Because of the lower overall false-positive rate leading to fewer procedure-related miscarriages, the Contingent Sequential resulted in the highest quality-adjusted life years as well. The Contingent Sequential remained the most cost-effective option throughout sensitivity analysis of inputs, including amniocentesis rate after positive screen, rate of therapeutic abortion after Down syndrome diagnosis, and rate of procedure-related miscarriages. CONCLUSION: Analysis of this actual data from the FASTER Trial demonstrates that the Contingent Sequential test is the most cost-effective. This information can help shape future policy regarding Down syndrome screening
— id: 76479, year: 2007, vol: 110, page: 10, stat: Journal Article,

The effect of low body mass index on the development of gestational hypertension and preeclampsia
Belogolovkin, Victoria; Eddleman, Keith A; Malone, Fergal D; Sullivan, Lisa; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Carter, Suzanne; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2007 Jul;20(7):509-513, Journal of maternal-fetal & neonatal medicine
OBJECTIVES: To evaluate the relationship between low maternal body mass index (BMI) as calculated in the first trimester and the risk of preeclampsia and gestational hypertension. METHODS: Patients enrolled in the First And Second Trimester Evaluation of Risk for aneuploidy (FASTER) trial were grouped into three weight categories: low BMI (BMI <19.8 kg/m2), normal BMI (BMI 19.8 - 26 kg/m2), and overweight BMI (26.1 - 29 kg/m2). The incidences of gestational hypertension and preeclampsia were ascertained for each group. Tests for differences in crude incidence proportions were performed using Chi-square tests. Multiple logistic regression was used to adjust for maternal age, race, parity, obesity, use of assisted reproductive technology (ART), in vitro fertilization (IVF), gestational diabetes, pre-gestational diabetes, cocaine use, and smoking. RESULTS: The proportion of patients having gestational hypertension in the low BMI group was 2.0% compared to 3.2% for normal BMI and 6.0% for overweight BMI (p < 0.0001). Women with low BMI were also less likely to develop preeclampsia, 1.1% vs. 1.9% for normal BMI and 2.8% for overweight BMI (p < 0.0001). CONCLUSIONS: We found that women with low BMI in the first trimester were significantly less likely to develop gestational hypertension or preeclampsia than women with a normal BMI
— id: 76477, year: 2007, vol: 20, page: 509, stat: Journal Article,

First- and second-trimester screening: detection of aneuploidies other than Down syndrome
Breathnach, Fionnuala M; Malone, Fergal D; Lambert-Messerlian, Geralyn; Cuckle, Howard S; Porter, T Flint; Nyberg, David A; Comstock, Christine H; Saade, George R; Berkowitz, Richard L; Klugman, Susan; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Tripp, Tara; Bianchi, Diana W; D'Alton, Mary E
2007 Sep;110(3):651-657, Obstetrics & gynecology
OBJECTIVE: To evaluate the performance of first- and second-trimester screening methods for the detection of aneuploidies other than Down syndrome. METHODS: Patients with singleton pregnancies at 10 weeks 3 days through 13 weeks 6 days of gestation were recruited at 15 U.S. centers. All patients had a first-trimester nuchal translucency scan, and those without cystic hygroma had a combined test (nuchal translucency, pregnancy-associated plasma protein A, and free beta-hCG) and returned at 15-18 weeks for a second-trimester quadruple screen (serum alpha-fetoprotein, total hCG, unconjugated estriol, and inhibin-A). Risk cutoff levels of 1:300 for Down syndrome and 1:100 for trisomy 18 were selected. RESULTS: Thirty-six thousand one hundred seventy-one patients completed first-trimester screening, and 35,236 completed second-trimester screening. There were 77 cases of non-Down syndrome aneuploidies identified in this population; 41 were positive for a cystic hygroma in the first trimester, and a further 36 had a combined test, of whom 29 proceeded to quadruple screening. First-trimester screening, by cystic hygroma determination or combined screening had a 78% detection rate for all non-Down syndrome aneuploidies, with an overall false-positive rate of 6.0%. Sixty-nine percent of non-Down syndrome aneuploidies were identified as screen-positive by the second-trimester quadruple screen, at a false-positive rate of 8.9%. In the combined test, the use of trisomy 18 risks did not detect any additional non-Down syndrome aneuploidies compared with the Down syndrome risk alone. In second-trimester quadruple screening, a trisomy 18-specific algorithm detected an additional 41% non-Down syndrome aneuploidies not detected using the Down syndrome algorithm. CONCLUSION: First-trimester Down syndrome screening protocols can detect the majority of cases of non-Down aneuploidies. Addition of a trisomy 18-specific risk algorithm in the second trimester achieves high detection rates for aneuploidies other than Down syndrome. LEVEL OF EVIDENCE: II
— id: 76476, year: 2007, vol: 110, page: 651, stat: Journal Article,

Preconceptional folate prevents preterm delivery
Bukowski, R; Malone, FD; Porter, F; Nyberg, DA; Comstock, C; Hankins, G; Eddleman, K; Gross, S; Dugoff, L; Craigo, S; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2007 DEC ;197(6):S3-S3, American journal of obstetrics & gynecology
— id: 87159, year: 2007, vol: 197, page: S3, stat: Journal Article,

Extremes of fetal growth are associated with spontaneous preterm birth
Bukowski, R; Malone, FD; Porter, F; Nyberg, DA; Comstock, C; Hankins, G; Eddleman, K; Gross, S; Dugoff, L; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2007 DEC ;197(6):S47-S47, American journal of obstetrics & gynecology
— id: 87161, year: 2007, vol: 197, page: S47, stat: Journal Article,

Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study
Bukowski, Radek; Smith, Gordon C S; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2007 Apr 21;334(7598):836-836, British medical journal. BMJ (International ed.)
OBJECTIVE: To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant. DESIGN: Prospective cohort study of 38 033 pregnancies between 1999 and 2003. SETTING: 15 centres representing major regions of the United States. PARTICIPANTS: 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. MAIN OUTCOME MEASURES: Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant. RESULTS: For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy. CONCLUSION: Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity
— id: 76480, year: 2007, vol: 334, page: 836, stat: Journal Article,

Human sexual size dimorphism in early pregnancy
Bukowski, Radek; Smith, Gordon C S; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2007 May 15;165(10):1216-1218, American journal of epidemiology
Sexual size dimorphism is thought to contribute to the greater mortality and morbidity of men compared with women. However, the timing of onset of sexual size dimorphism remains uncertain. The authors determined whether human fetuses exhibit sexual size dimorphism in the first trimester of pregnancy. Using a prospective cohort study, conducted in 1999-2002 in the United States, they identified 27,655 women who conceived spontaneously and 1,008 whose conception was assisted by in vitro fertilization or intrauterine insemination and for whom a first-trimester measurement of fetal crown-rump length was available. First-trimester size was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. The authors evaluated the association between fetal sex, first-trimester size, and birth weight. Eight to 12 weeks after conception, males were larger than females (mean difference: assisted conception = 0.4 days, 95% confidence interval (CI): 0.1, 0.7, p = 0.008; spontaneous conception = 0.3 days, 95% CI: 0.2, 0.4, p < 0.00001). The size discrepancy remained significant at birth (mean birth weight difference: assisted conception = 90 g, 95% CI: 22, 159, p = 0.009; spontaneous conception = 120 g, 95% CI: 107, 132, p < 0.00001). These data demonstrate that human fetuses exhibit sexual size dimorphism in the first trimester of pregnancy
— id: 73881, year: 2007, vol: 165, page: 1216, stat: Journal Article,

The contribution of birth defects to preterm birth and low birth weight
Dolan, Siobhan M; Gross, Susan J; Merkatz, Irwin R; Faber, Vincent; Sullivan, Lisa M; Malone, Fergal D; Porter, T Flint; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Eddleman, Keith; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary E
2007 Aug;110(2 Pt 1):318-324, Obstetrics & gynecology
OBJECTIVE: To assess the impact of birth defects on preterm birth and low birth weight. METHODS: Data from a large, prospective multi-center trial, the First and Second Trimester Evaluation of Risk (FASTER) Trial, were examined. All live births at more than 24 weeks of gestation with data on outcome and confounders were divided into two comparison groups: 1) those with a chromosomal or structural abnormality (birth defect) and 2) those with no abnormality detected in chromosomes or anatomy. Propensity scores were used to balance the groups, account for confounding, and reduce the bias of a large number of potential confounding factors in the assessment of the impact of a birth defect on outcome. Multiple logistic regression analysis was applied. RESULTS: A singleton liveborn infant with a birth defect was 2.7 times more likely to be delivered preterm before 37 weeks of gestation (95% confidence interval [CI] 2.3-3.2), 7.0 times more likely to be delivered preterm before 34 weeks (95% CI 5.5-8.9), and 11.5 times more likely to be delivered very preterm before 32 weeks (95% CI 8.7-15.2). A singleton liveborn with a birth defect was 3.6 times more likely to have low birth weight at less than 2,500 g (95% CI 3.0-4.3) and 11.3 times more likely to be very low birth weight at less than 1,500 g (95% CI 8.5-15.1). CONCLUSION: Birth defects are associated with preterm birth and low birth weight after controlling for multiple confounding factors, including shared risk factors and pregnancy complications, using propensity scoring adjustment in multivariable regression analysis. The independent effects of risk factors on perinatal outcomes such as preterm birth and low birth weight, usually complicated by numerous confounding factors, may benefit from the application of this methodology, which can be used to minimize bias and account for confounding. Furthermore, this suggests that clinical and public health interventions aimed at preventing birth defects may have added benefits in preventing preterm birth and low birth weight. LEVEL OF EVIDENCE: II
— id: 76478, year: 2007, vol: 110, page: 318, stat: Journal Article,

Ultrasound of the Fetal Brain
Monteagudo A.; Timor-Tritsch I.E.
2007 ;2(2):217-244, Ultrasound Clinics
Ultrasound examination of the fetal central nervous system (CNS) distinguishes itself from the sonographic evaluation of all other organs or organ systems because during the course of pregnancy, the CNS (mainly the fetal brain) undergoes significant changes, in size and in the shape of its different anatomic regions, which follow a well-defined timeline and can be recognized sonographically. The developmental milestones of the CNS from the time of its first sonographic detection to term can, and should, be taken into consideration when a fetal neurosonogram is performed. This article describes a systematic approach to the evaluation of the fetal brain by discussing the differential diagnosis of two important sonographic findings, namely ventriculomegaly and an enlarged posterior fossa, and by touching on other important brain abnormalities. copyright 2007 Elsevier Inc. All rights reserved
— id: 97870, year: 2007, vol: 2, page: 217, stat: Journal Article,

Combining first and second trimester Down syndrome screening results: A simple, effective approximation
Rosen, T; Cuckle, H; Malone, F; Porter, F; Nyberg, D; Comstock, C; Bukowski, R; Berkowitz, R; Gross, SJ; Dugoff, L; Craigo, S; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; Bianchi, D; D'Alton, ME
2007 DEC ;197(6):S14-S14, American journal of obstetrics & gynecology
— id: 87160, year: 2007, vol: 197, page: S14, stat: Journal Article,

Intrauterine subdural hemorrhage associated with profound deficiency of the vitamin K dependent clotting factors in an infant homozygous for a common polymorphism in the vitamin K epoxide reductase complex 1 (VKORC1) promoter
Schwartz, N; Oldenburg, J; Hart, D; Nardi, M; Most, OL; Bonanno, C; Timor-Tritsch, IT; Karpatkin, M
2007 NOV 16 ;110(11):640A-641A, Blood
— id: 76183, year: 2007, vol: 110, page: 640A, stat: Journal Article,

Nuchal translucency and the risk of congenital heart disease
Simpson, Lynn L; Malone, Fergal D; Bianchi, Diana W; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Saade, George; Eddleman, Keith; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Tripp, Tara; D'Alton, Mary E
2007 Feb;109(2 Pt 1):376-383, Obstetrics & gynecology
OBJECTIVE: To estimate whether nuchal translucency assessment is a useful screening tool for major congenital heart disease (CHD) in the absence of aneuploidy. METHODS: Unselected patients with singleton pregnancies at 10(3/7) to 13(6/7) weeks of gestation were recruited at 15 U.S. centers to undergo nuchal translucency sonography. Screening characteristics of nuchal translucency in the detection of major CHD were determined using different cutoffs (2.0 or more multiples of the median [MoM], 2.5 or more MoM, 3.0 or more MoM). RESULTS: A total of 34,266 euploid fetuses with cardiac outcome data were available for analysis. There were 224 cases of CHD (incidence 6.5 per 1,000), of which 52 (23.2%) were major (incidence 1.5 per 1,000). The incidence of major CHD increased with increasing nuchal translucency: 14.1 per 1,000, 33.5 per 1,000, and 49.5 per 1,000 at 2.0 or more MoM, 2.5 or more MoM, and 3.0 or more MoM cutoffs, respectively. Sensitivity, specificity, and positive predictive values were 15.4%, 98.4%, and 1.4% at 2.0 or more MoM; 13.5%, 99.4%, and 3.3% at 2.5 or more MoM; and 9.6%, 99.7%, and 5.0% at 3.0 or more MoM. Nuchal translucency of 2.5 or more MoM (99th percentile) had a likelihood ratio (95% confidence interval) of 22.5 (11.4-45.5) for major CHD. Based on our data, for every 100 patients referred for fetal echocardiography with a nuchal translucency of 99th percentile or more, three will have a major cardiac anomaly. CONCLUSION: Nuchal translucency sonography in the first trimester lacks the characteristics of a good screening tool for major CHD in a large unselected population. However, nuchal translucency of 2.5 or more MoM (99th percentile or more) should be considered an indication for fetal echocardiography. LEVEL OF EVIDENCE: II
— id: 76481, year: 2007, vol: 109, page: 376, stat: Journal Article,

Ultrasound in gynecology
Timor-Tritsch, Ilan E; Goldstein, Steven R
Philadelphia : Elsevier Churchill Livingstone, 2007,
Ultrasound in gynecology: development and continuing evolution -- Applied physics: selecting and adjusting the equipment -- Instrumentation, modality selection, and documentation -- Conducting the gynecologic ultrasound examination -- Relevant pelvic anatomy -- Adenomyosis -- Congenital uterine anomalies -- Adnexal masses -- Menopausal dilemmas: how ultrasound has changed clinical management -- Lower urinary tract -- Early pregnancy -- Pregnancy failure -- Ectopic pregnancy -- Infertility -- Sonohysterography -- Ultrasound-guided procedures in gynecology -- Color doppler mapping in gynecology -- Transvaginal sonography and ovarian cancer -- Three-dimensional ultrasound in gynecology -- Ultrasound-enhanced bimanual examination -- Differential diagnosis of inflammatory diseases of the pelvis -- Pearls and pitfalls of transvaginal sonography
— id: 1387, year: 2007, vol: , page: , stat: ,

Three and four-dimensional ultrasound in obstetrics and gynecology
Timor-Tritsch, Ilan E; Monteagudo, Ana
2007 Apr;19(2):157-175, Current opinion in obstetrics & gynecology
PURPOSE OF REVIEW: Developments in ultrasound in general, but even more so in three-dimensional ultrasound, parallel the growth in computing power and speed of computer technology. It is not surprising, therefore, that three-dimensional ultrasound technology is constantly evolving at a fast pace. The purpose of this article is to provide enhanced diagnostic capabilities for the obstetrical and gynecologic provider. RECENT FINDINGS: The most recent advances in three-dimensional ultrasound have to do with two main features. First, an increasingly fast acquisition speed, enabling quick sequences of fast moving organs such as the heart to be captured. Second, the increasing number of different display modalities, making understanding and analysis of normal anatomy and pathology easier for clinicians. SUMMARY: This article highlights a selected number of clinical situations in which three-dimensional ultrasound meaningfully enhances the contribution of this fast evolving diagnostic imaging tool
— id: 72539, year: 2007, vol: 19, page: 157, stat: Journal Article,

Early pregnancy growth determines low birth weight
Bukowski, R; Smith, GCS; Malone, FD; Ball, RH; Comstock, C; Nyberg, DA; Hankins, G; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, S; Wolfe, HM; D'Alton, ME
2006 DEC ;195(6):S194-S194, American journal of obstetrics & gynecology
— id: 71058, year: 2006, vol: 195, page: S194, stat: Journal Article,

Faster growth of male fetuses in first trimester of pregnancy
Bukowski, R; Smith, GCS; Malone, FD; Ball, RH; Nyberg, DA; Comstock, C; Hankins, G; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2006 DEC ;195(6):S134-S134, American journal of obstetrics & gynecology
— id: 71057, year: 2006, vol: 195, page: S134, stat: Journal Article,

Comparison of serum markers in first-trimester down syndrome screening
Canick, Jacob A; Lambert-Messerlian, Geralyn M; Palomaki, Glenn E; Neveux, Louis M; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Bukowski, Radek; Saade, George R; Berkowitz, Richard L; Dar, Pe'er; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2006 Nov;108(5):1192-1199, Obstetrics & gynecology
OBJECTIVE: To estimate patterns of total hCG and inhibin A levels in the late first trimester of Down syndrome pregnancies, compare them with that of free beta-hCG, and assess screening performance of these markers individually and in combination with pregnancy-associated plasma protein-A (PAPP-A) and nuchal translucency. METHODS: Seventy-nine matched case-control sets of maternal serum samples (each Down syndrome case matched to 5 controls) from 11 through 13 completed weeks of gestation were taken from the sample bank of the First and Second Trimester Evaluation of Risk Consortium, a population-based study, and assayed for levels of free beta-hCG, total hCG, and inhibin A. Distribution characteristics and correlations of the multiples of the median values were estimated in cases and controls. Screening performance for each marker, alone and in combination with PAPP-A, nuchal translucency, and maternal age, was calculated. RESULTS: Median multiples of the median levels of free beta-hCG, total hCG, and inhibin A in cases were more elevated as gestation increased from 11 to 13 weeks, with univariate detection rates of 31%, 23%, and 29%, respectively, at a 5% false-positive rate. At 12 weeks, the multivariate detection rates at a 5% false-positive rate for nuchal translucency and PAPP-A (with maternal age) with either free beta-hCG, total hCG, or inhibin A were 84%, 83%, and 85%, respectively. The improvement in performance from nuchal translucency and PAPP-A to any of the three-marker tests was significant, while performance of any of the three-marker combinations was not significantly different from each other. CONCLUSION: Although levels of free beta-hCG in affected pregnancies were higher earlier than the levels of either total hCG or inhibin A, there was no significant difference in screening performance when either of the three markers was used with nuchal translucency and PAPP-A at 11-13 weeks of pregnancy. LEVEL OF EVIDENCE: II-2
— id: 76482, year: 2006, vol: 108, page: 1192, stat: Journal Article,

Is there a nuchal translucency millimeter measurement above which there is no added benefit from first trimester serum screening?
Comstock, Christine H; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Saade, George R; Berkowitz, Richard L; Ferreira, Jose; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary E
2006 Sep;195(3):843-847, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of this study was to evaluate whether there is a nuchal translucency (NT) measurement, independent of gestational age, above which immediate diagnostic testing should be offered without waiting for first trimester serum markers. STUDY DESIGN: Thirty-six thousand one hundred twenty patients had successful measurement of simple NT at 10 3/7 to 13 6/7 weeks and had first trimester serum screening. No risks were reported until second trimester serum screening was completed. RESULTS: Thirty-two patients (0.09%) had NT > or = 4.0 mm; the lowest combined first trimester trisomy 21 risk assessment in euploid cases was 1 in 8 and among aneuploidy cases was 7 in 8. One hundred twenty-eight patients (0.3%) had simple NT > or = 3.0 mm: the lowest combined first trimester trisomy 21 risk assessment of any patient in this group was 1 in 1479 and the lowest risk assessment among aneuploid cases was 1 in 2. Ten patients (8%) had first trimester trisomy 21 risk assessments lowered to less that 1:200 and none of these 10 cases had an abnormal outcome. CONCLUSION: During first trimester Down syndrome screening, whenever an NT measurement of 3.0 mm or greater is obtained there is minimal benefit in waiting for serum screening results, and no benefit for NT of 4.0 mm or greater. Differentiation between cystic hygroma and enlarged simple NT (> or = 3.0 mm) is now a moot point as both are sufficiently high risk situations to warrant immediate CVS
— id: 76485, year: 2006, vol: 195, page: 843, stat: Journal Article,

Two- and 3-dimensional sonographic diagnosis of a vesicorectal fistula in cloacal dysgenesis sequence
Dulay, Antonette T; Schwartz, Nadav; Laser, Alice; Greco, M Alba; Monteagudo, Ana; Timor-Tritsch, Ilan E
2006 Nov;25(11):1489-1494, Journal of ultrasound in medicine
— id: 73011, year: 2006, vol: 25, page: 1489, stat: Journal Article,

Pregnancy loss rates after midtrimester amniocentesis
Eddleman, Keith A; Malone, Fergal D; Sullivan, Lisa; Dukes, Kim; Berkowitz, Richard L; Kharbutli, Yara; Porter, T Flint; Luthy, David A; Comstock, Christine H; Saade, George R; Klugman, Susan; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2006 Nov;108(5):1067-1072, Obstetrics & gynecology
OBJECTIVE: The purpose of this study was to quantify the contemporary procedure-related loss rate after midtrimester amniocentesis using a database generated from patients who were recruited to the First And Second Trimester Evaluation of Risk for Aneuploidy trial. METHODS: A total of 35,003 unselected patients from the general population with viable singleton pregnancies were enrolled in the First And Second Trimester Evaluation of Risk for Aneuploidy trial between 10 3/7 and 13 6/7 weeks gestation and followed up prospectively for complete pregnancy outcome information. Patients who either did (study group, n=3,096) or did not (control group, n=31,907) undergo midtrimester amniocentesis were identified from the database. The rate of fetal loss less than 24 weeks of gestation was compared between the two groups, and multiple logistic regression analysis was used to adjust for potential confounders. RESULTS: The spontaneous fetal loss rate less than 24 weeks of gestation in the study group was 1.0% and was not statistically different from the background 0.94% rate seen in the control group (P=.74, 95% confidence interval -0.26%, 0.49%). The procedure-related loss rate after amniocentesis was 0.06% (1.0% minus the background rate of 0.94%). Women undergoing amniocentesis were 1.1 times more likely to have a spontaneous loss (95% confidence interval 0.7-1.5). CONCLUSION: The procedure-related fetal loss rate after midtrimester amniocentesis performed on patients in a contemporary prospective clinical trial was 0.06%. There was no significant difference in loss rates between those undergoing amniocentesis and those not undergoing amniocentesis. LEVEL OF EVIDENCE: II-2
— id: 76483, year: 2006, vol: 108, page: 1067, stat: Journal Article,

Early access to prenatal care: implications for racial disparity in perinatal mortality
Healy, Andrew J; Malone, Fergal D; Sullivan, Lisa M; Porter, T Flint; Luthy, David A; Comstock, Christine H; Saade, George; Berkowitz, Richard; Klugman, Susan; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary E
2006 Mar;107(3):625-631, Obstetrics & gynecology
OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care. LEVEL OF EVIDENCE: II-2
— id: 76489, year: 2006, vol: 107, page: 625, stat: Journal Article,

Schizencephaly in a dysgenetic fetal brain: prenatal sonographic, magnetic resonance imaging, and postmortem correlation
Huang, William M; Monteagudo, Ana; Bennett, Genevieve L; Fowkes, Mary E; Timor-Tritsch, Ilan E
2006 Apr;25(4):551-554, Journal of ultrasound in medicine
— id: 66250, year: 2006, vol: 25, page: 551, stat: Journal Article,

First- and second-trimester Down syndrome screening markers in pregnancies achieved through assisted reproductive technologies (ART): a FASTER trial study
Lambert-Messerlian, G; Dugoff, L; Vidaver, J; Canick, J A; Malone, F D; Ball, R H; Comstock, C H; Nyberg, D A; Saade, G; Eddleman, K; Klugman, S; Craigo, S D; Timor-Tritsch, I E; Carr, S R; Wolfe, H M; D'Alton, M E
2006 Aug;26(8):672-678, Prenatal diagnosis
OBJECTIVE: To determine whether first- and second-trimester Down syndrome screening markers and screen-positive rates are altered in pregnancies conceived using assisted reproductive technologies (ARTs). METHODS: ART pregnancies in the multicenter FASTER trial were identified. Marker levels were evaluated for five types of ART: in vitro fertilization with ovulation induction (IVF-OI), IVF with OI and egg donation (IVF-OI-ED), IVF with ED (IVF-ED), and intrauterine insemination with OI (IUI-OI) or without OI (IUI). Each group was compared to non-ART controls using Mann-Whitney U analysis. RESULTS: First-trimester marker levels were not significantly different between ART and control pregnancies, with the exception of reduced PAPP-A levels in the IUI-OI group. In contrast, second-trimester inhibin A levels were increased in all ART pregnancies, estriol was reduced and human chorionic gonadotropin (hCG) was increased in IVF and IUI pregnancies without ED, and alpha-fetoprotein (AFP) was increased in ED pregnancies. Second-trimester screen-positive rates were significantly higher than expected for ART pregnancies, except when ED was used. CONCLUSIONS: These data show that ART significantly impacts second-, but not first-, trimester markers and screen-positive rates. The type of adjustment needed in second-trimester screening depends on the particular type of ART used
— id: 76487, year: 2006, vol: 26, page: 672, stat: Journal Article,

First-trimester septated cystic hygroma: Prevalence, natural history, and pediatric outcome - Reply
Malone, FD; Ball, RH; Nyberg, DA; Comstock, CH; Saade, GR; Berkowitz, RL; Saade, GR; Berkowitz, RL; Gross, S; Dugoff, L; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; Dukes, K; Canick, JA; Bianchi, DW; D'Alton, ME
2006 FEB ;107(2):425-425, Obstetrics & gynecology
— id: 68998, year: 2006, vol: 107, page: 425, stat: Journal Article,

Repeated measures screening for trisomy 21 - Results from a general population screening trial (the faster trial)
Malone, FO; Wright, D; Cuckle, H; Ball, RH; Nyberg, DA; Comstock, CH; Saade, GR; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; D'Alton Mary, E
2006 DEC ;195(6):S13-S13, American journal of obstetrics & gynecology
— id: 71056, year: 2006, vol: 195, page: S13, stat: Journal Article,

Fetal fibular hemimelia: case report and review of the literature
Monteagudo, Ana; Dong, Ran; Timor-Tritsch, Ilan E
2006 Apr;25(4):533-537, Journal of ultrasound in medicine
— id: 67945, year: 2006, vol: 25, page: 533, stat: Journal Article,

Real-time and 3-dimensional sonographic diagnosis of postural congenital genu recurvatum
Monteagudo, Ana; Kudla, Marek M; Essig, Mitchell; Santos, Rosalba; Timor-Tritsch, Ilan E
2006 Aug;25(8):1079-1083, Journal of ultrasound in medicine
— id: 76486, year: 2006, vol: 25, page: 1079, stat: Journal Article,

Assisted reproductive technology and pregnancy outcome - Reply
Shevell, T; Malone, FD; Vidaver, J; Porter, TF; Luthy, DA; Comstock, CH; Hankins, GD; Eddleman, K; Dolan, S; Dugoff, L; Cralgo, S; Timor, IE; Carr, SR; Wolfe, HM; Bianchi, DW; D'Alton, ME
2006 APR ;107(4):953-954, Obstetrics & gynecology
— id: 68999, year: 2006, vol: 107, page: 953, stat: Journal Article,

Re: fetal magnetic resonance imaging: luxury or necessity?
Timor-Tritsch, I
2006 Nov;28(6):859-860, Ultrasound in obstetrics & gynecology
— id: 76484, year: 2006, vol: 28, page: 859, stat: Journal Article,

As technology evolves, so should its application: shortcomings of the "18-week anatomy scan"
Timor-Tritsch, Ilan E
2006 Apr;25(4):423-428, Journal of ultrasound in medicine
— id: 76488, year: 2006, vol: 25, page: 423, stat: Journal Article,

Three- and 4-dimensional ultrasound in obstetrics and gynecology: proceedings of the american institute of ultrasound in medicine consensus conference
Benacerraf, Beryl R; Benson, Carol B; Abuhamad, Alfred Z; Copel, Joshua A; Abramowicz, Jacques S; Devore, Greggory R; Doubilet, Peter M; Lee, Wesley; Lev-Toaff, Anna S; Merz, Eberhard; Nelson, Thomas R; O'Neill, Mary Jane; Parsons, Anna K; Platt, Lawrence D; Pretorius, Dolores H; Timor-Tritsch, Ilan E
2005 Dec;24(12):1587-1597, Journal of ultrasound in medicine
The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology
— id: 76490, year: 2005, vol: 24, page: 1587, stat: Journal Article,

Impact of maternal age on obstetric outcome
Cleary-Goldman, Jane; Malone, Fergal D; Vidaver, John; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Saade, George R; Eddleman, Keith A; Klugman, Susan; Dugoff, Lorraine; Timor-Tritsch, Ilan E; Craigo, Sabrina D; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary
2005 May;105(5 Pt 1):983-990, Obstetrics & gynecology
OBJECTIVE: To estimate the effect of maternal age on obstetric outcomes. METHODS: A prospective database from a multicenter investigation of singletons, the FASTER trial, was studied. Subjects were divided into 3 age groups: 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Multivariable logistic regression analysis was used to assess the effect of age on outcomes after adjusting for race, parity, body mass index, education, marital status, smoking, medical history, use of assisted conception, and patient's study site. RESULTS: A total of 36,056 women with complete data were available: 28,398 (79%) less than 35 years of age; 6,294 (17%) 35-39 years; and 1,364 (4%) 40 years and older. Increasing age was significantly associated with miscarriage (adjusted odds ratio [adjOR]2.0 and 2.4 for ages 35-39 years and age 40 years and older, respectively), chromosomal abnormalities (adjOR 4.0 and 9.9), congenital anomalies (adjOR 1.4 and 1.7), gestational diabetes (adjOR 1.8 and 2.4), placenta previa (adjOR 1.8 and 2.8), and cesarean delivery (adjOR 1.6 and 2.0). Patients aged 35-39 years were at increased risk for macrosomia (adjOR 1.4). Increased risk for abruption (adjOR 2.3), preterm delivery (adjOR 1.4), low birth weight (adjOR 1.6), and perinatal mortality (adjOR 2.2) was noted in women aged 40 years and older. CONCLUSION: Increasing maternal age is independently associated with specific adverse pregnancy outcomes. Increasing age is a continuum rather than a threshold effect
— id: 62315, year: 2005, vol: 105, page: 983, stat: Journal Article,

Quad screen as a predictor of adverse pregnancy outcome
Dugoff, Lorraine; Hobbins, John C; Malone, Fergal D; Vidaver, John; Sullivan, Lisa; Canick, Jacob A; Lambert-Messerlian, Geralyn M; Porter, T Flint; Luthy, David A; Comstock, Christine H; Saade, George; Eddleman, Keith; Merkatz, Irwin R; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E
2005 Aug;106(2):260-267, Obstetrics & gynecology
OBJECTIVE: To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database). METHODS: The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks. We analyzed the data to identify associations between the quad screen markers and preterm birth, intrauterine growth restriction, preeclampsia, and fetal loss. Our analysis was performed by evaluating the performance characteristics of quad screen markers individually and in combination. Crude and adjusted effects were estimated by multivariable logistic regression analysis. Patients with fetal anomalies were excluded from the analysis. RESULTS: We analyzed data from 33,145 pregnancies. We identified numerous associations between the markers and the adverse outcomes. There was a relatively low, but often significant, risk of having an adverse pregnancy complication if a patient had a single abnormal marker. However, the risk of having an adverse outcome increased significantly if a patient had 2 or more abnormal markers. The sensitivity and positive predictive values using combinations of markers is relatively low, although superior to using individual markers. CONCLUSION: These data suggest that components of the quad screen may prove useful in predicting adverse obstetric outcomes. We also showed that the total number and specific combinations of abnormal markers are most useful in predicting the risk of adverse perinatal outcome
— id: 76493, year: 2005, vol: 106, page: 260, stat: Journal Article,

The role of ultrasound evaluation in the detection of early-stage epithelial ovarian cancer
Fishman, David A; Cohen, Leeber; Blank, Stephanie V; Shulman, Lee; Singh, Diljeet; Bozorgi, Kenny; Tamura, Ralph; Timor-Tritsch, Ilan; Schwartz, Peter E
2005 Apr;192(4):1214-1221, American journal of obstetrics & gynecology
OBJECTIVE: Epithelial ovarian cancer kills more women than all other gynecologic malignancies combined because of our inability to detect early-stage disease. Ultrasonography has demonstrated usefulness in the detection of ovarian cancer in asymptomatic women, but its value for the detection of early-stage epithelial ovarian cancer in women of increased risk is uncertain. We examined the usefulness of sonography in the detection of early-stage epithelial ovarian cancer in asymptomatic high-risk women who participated in the National Ovarian Cancer Early Detection Program. STUDY DESIGN: Only asymptomatic women of increased risk for the development of ovarian cancer with initial normal gynecologic and ultrasound examinations were eligible to participate in the institutional review board-approved National Ovarian Cancer Early Detection Program. Participants underwent comprehensive gynecologic and ultrasound examinations every 6 months. Increased risk includes women with at least 1 affected first-degree relative with ovarian cancer; a personal history of breast, ovarian, or colon cancer; > or =1 affected first- and second-degree relatives with breast and or ovarian cancer; inheritance of a breast cancer mutation from an affected family member, or membership within a recognized cancer syndrome. RESULTS: The average age of the 4526 women who were evaluated was 46 years; 2610 women were premenopausal, and 1916 women were postmenopausal. A total of 12,709 scans have been performed since 1990. Visualization of both ovaries was noted in 98% of premenopausal and in 94% of postmenopausal women. Fourteen women had undergone unilateral salpingo-oophorectomy. Recall rates at less than the routine 6-month interval were 0.4% in the premenopausal and 0.3% in postmenopausal women. A total of 98 women with persistent adnexal masses were identified, and 49 invasive surgical procedures were performed that diagnosed 37 benign ovarian tumors and 12 gynecologic malignancies. All cancers were detected in asymptomatic women who had normal ultrasound and physical examinations 12 and 6 months before the cancer diagnosis. The detected malignancies were fallopian tube carcinoma (stage IIIC; n = 4 women), primary peritoneal carcinoma (n = 4 women; stage IIIA, 1 woman; stage IIIB, 2 women; stage IIIC, 1 woman), epithelial ovarian cancer (stages IIIA and IIIB; n = 2 women), and endometrial adenocarcinoma (stage IA; n = 2 women). Additionally 37 primary and 12 recurrent breast carcinomas were detected by physical examination. A total of 184 women with genetic predisposition (breast cancer positive) have undergone a prophylactic bilateral salpingo-oophorectomy; 23% of these procedures found atypical hyperplasia, and unexpectedly, 2 women (1%) were found to have stage III (A and B) primary peritoneal carcinoma. CONCLUSION: This study demonstrates the limited value of diagnostic ultrasound examination as an independent modality for the detection of early-stage epithelial ovarian cancer in asymptomatic women who are at increased risk for disease
— id: 55609, year: 2005, vol: 192, page: 1214, stat: Journal Article,

First-trimester septated cystic hygroma: Prevalence, natural history, and pediatric outcome - Reply
Malone, FD; Ball, RH; Nyberg, DA; Comstock, CH; Saade, GR; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor-Tritsch, IE; Carr, SR; Wolfe, HM; Dukes, K; Canick, JA; Bianchi, DW; D'Alton, ME
2005 DEC ;106(6):1415-1416, Obstetrics & gynecology
— id: 60201, year: 2005, vol: 106, page: 1415, stat: Journal Article,

Mom versus Delta
Malone, FD; Cuckle, H; Ball, RH; Nyberg, DA; Comstock, CH; Bukowski, R; Eddleman, K; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; Dukes, KA; D'Alton, ME
2005 DEC ;193(6):S162-S162, American journal of obstetrics & gynecology
— id: 61902, year: 2005, vol: 193, page: S162, stat: Journal Article,

Contingent screening for Trisomy 21 - Results from a general population screening trial
Malone, FD; Cuckle, H; Ball, RH; Nyberg, DA; Comstock, CH; Saade, G; Berkowitz, RL; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; Dukes, KA; D'Alton, ME
2005 DEC ;193(6):S29-S29, American journal of obstetrics & gynecology
— id: 61901, year: 2005, vol: 193, page: S29, stat: Journal Article,

First-trimester septated cystic hygroma: prevalence, natural history, and pediatric outcome
Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Saade, George R; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Dukes, Kimberly; Canick, Jacob A; Bianchi, Diana W; D'Alton, Mary E
2005 Aug;106(2):288-294, Obstetrics & gynecology
OBJECTIVE: To estimate prevalence, natural history, and outcome of septated cystic hygroma in the first trimester in the general obstetric population, and to differentiate this finding from simple increased nuchal translucency. METHODS: Patients at 10.3-13.6 weeks of gestation underwent nuchal translucency sonography as part of a multicenter clinical trial. Septated cystic hygroma cases were offered chorionic villi sampling for karyotype, and targeted fetal anatomical and cardiac evaluations. Survivors were followed up for fetal and long-term pediatric outcome (median 25 months, range 12-50 months). Cases of septated cystic hygroma were also compared with cases of simple increased nuchal translucency. RESULTS: There were 134 cases of cystic hygroma (2 lost to follow-up) among 38,167 screened patients (1 in 285). Chromosomal abnormalities were diagnosed in 67 (51%), including 25 trisomy-21, 19 Turner syndrome, 13 trisomy-18, and 10 others. Major structural fetal malformations (primarily cardiac and skeletal) were diagnosed in 22 of the remaining 65 cases (34%). There were 5 cases (8%) of fetal death and 15 cases of elective pregnancy termination without evidence of abnormality. One of 23 (4%) normal survivors was diagnosed with cerebral palsy and developmental delay. Overall, survival with normal pediatric outcome was confirmed in 17% of cases (22 of 132). Compared with simple increased nuchal translucency, cystic hygroma has 5-fold, 12-fold, and 6-fold increased risk of aneuploidy, cardiac malformation, and perinatal death, respectively. CONCLUSION: First-trimester cystic hygroma was a frequent finding in a general obstetric screening program. It has the strongest prenatal association with aneuploidy described to date, with significantly worse outcome compared with simple increased nuchal translucency. Most pregnancies with normal evaluation at the completion of the second trimester resulted in a healthy infant with a normal pediatric outcome
— id: 76492, year: 2005, vol: 106, page: 288, stat: Journal Article,

First-trimester or second-trimester screening, or both, for Down's syndrome
Malone, Fergal D; Canick, Jacob A; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Bukowski, Radek; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; Dukes, Kimberly; Bianchi, Diana W; Rudnicka, Alicja R; Hackshaw, Allan K; Lambert-Messerlian, Geralyn; Wald, Nicholas J; D'Alton, Mary E
2005 Nov 10;353(19):2001-2011, New England journal of medicine
BACKGROUND: It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters. METHODS: Women with singleton pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation) and second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A at 15 through 18 weeks of gestation). We compared the results of stepwise sequential screening (risk results provided after each test), fully integrated screening (single risk result provided), and serum integrated screening (identical to fully integrated screening, but without nuchal translucency). RESULTS: First-trimester screening was performed in 38,167 patients; 117 had a fetus with Down's syndrome. At a 5 percent false positive rate, the rates of detection of Down's syndrome were as follows: with first-trimester combined screening, 87 percent, 85 percent, and 82 percent for measurements performed at 11, 12, and 13 weeks, respectively; with second-trimester quadruple screening, 81 percent; with stepwise sequential screening, 95 percent; with serum integrated screening, 88 percent; and with fully integrated screening with first-trimester measurements performed at 11 weeks, 96 percent. Paired comparisons found significant differences between the tests, except for the comparison between serum integrated screening and combined screening. CONCLUSIONS: First-trimester combined screening at 11 weeks of gestation is better than second-trimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down's syndrome, with low false positive rates
— id: 76491, year: 2005, vol: 353, page: 2001, stat: Journal Article,

Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series
Monteagudo, A; Minior, V K; Stephenson, C; Monda, S; Timor-Tritsch, I E
2005 Mar;25(3):282-288, Ultrasound in obstetrics & gynecology
OBJECTIVES: To describe a series of consecutive cases of live ectopic pregnancies managed with ultrasound-guided local injection of methotrexate (MTX) or potassium chloride (KCl). METHODS: Eighteen consecutive women with live and unruptured, tubal, cornual or cervical ectopic pregnancies referred to our unit for evaluation and management underwent risk-benefit counseling. Under transvaginal ultrasound guidance, puncture and injection of the ectopic pregnancy was performed using an automated puncture device. Either MTX or KCl was injected, producing immediate cessation of fetal cardiac activity. RESULTS: Of the 18 ectopic pregnancies, 10 were cervical, four were tubal and four were cornual. The mean initial beta-hCG level was 33 412 IU and the mean gestational age was 6 + 6 weeks. Ten ectopic gestational sacs were injected with KCl and eight were injected with MTX. There was no difference in time to resolution of the ectopic pregnancies between those injected with KCl and those with MTX. CONCLUSIONS: Unruptured live ectopic pregnancies of many types can be successfully managed without surgical intervention through local injection of KCl or MTX
— id: 55908, year: 2005, vol: 25, page: 282, stat: Journal Article,

Assisted reproductive technology and pregnancy outcome
Shevell, Tracy; Malone, Fergal D; Vidaver, John; Porter, T Flint; Luthy, David A; Comstock, Christine H; Hankins, Gary D; Eddleman, Keith; Dolan, Siobhan; Dugoff, Lorraine; Craigo, Sabrina; Timor, Ilan E; Carr, Stephen R; Wolfe, Honor M; Bianchi, Diana W; D'Alton, Mary E
2005 Nov;106(5 Pt 1):1039-1045, Obstetrics & gynecology
OBJECTIVE: To determine whether the use of assisted reproductive technology (ART) is associated with an increase in chromosomal abnormalities, fetal malformations, or adverse pregnancy outcomes. METHODS: A prospective database from a large multicenter investigation of singleton pregnancies, the First And Second Trimester Evaluation of Risk trial, was examined. Subjects were divided into 3 groups: no ART use, use of ovulation induction (with or without intrauterine insemination), and use of in vitro fertilization (IVF). Multivariate logistic regression analysis was used to assess association between ART and adverse pregnancy outcomes (significance of differences was accepted at P < .05). RESULTS: A total of 36,062 pregnancies were analyzed: 34,286 (95.1%) were spontaneously conceived, 1,222 (3.4%) used ovulation induction, and 554 (1.5%) used IVF. There was no association between ART and fetal growth restriction, aneuploidy, or fetal anomalies after adjustment for age, race, marital status, years of education, prior preterm delivery, prior fetal anomaly, body mass index, smoking history, and bleeding in the current pregnancy. Ovulation induction was associated with a statistically significant increase in placental abruption, fetal loss after 24 weeks, and gestational diabetes after adjustment. Use of IVF was associated with a statistically significant increase in preeclampsia, gestational hypertension, placental abruption, placenta previa, and risk of cesarean delivery. CONCLUSION: Patients who undergo IVF are at increased risk for several adverse pregnancy outcomes. Although many of these risks are not seen in patients undergoing ovulation induction, several adverse pregnancy outcomes are still increased in this group. There was no increased incidence of fetal chromosomal or structural abnormalities in the women who used any type of ART compared with the women who conceived spontaneously. LEVEL OF EVIDENCE: II-2
— id: 62322, year: 2005, vol: 106, page: 1039, stat: Journal Article,

The use of a 15-7-MHz 'small parts' linear transducer to evaluate the anal sphincter in female patients
Timor-Tritsch, I E; Monteagudo, A; Porges, R F; Santos, R
2005 Feb;25(2):206-209, Ultrasound in obstetrics & gynecology
— id: 56339, year: 2005, vol: 25, page: 206, stat: Journal Article,

Simple ultrasound evaluation of the anal sphincter in female patients using a transvaginal transducer
Timor-Tritsch, I E; Monteagudo, A; Smilen, S W; Porges, R F; Avizova, E
2005 Feb;25(2):177-183, Ultrasound in obstetrics & gynecology
OBJECTIVE: Fecal incontinence affects 0.2% of women aged 15-64 years and about 1.3% of women over 64 years. Most cases are related to instrumental deliveries affecting the anal sphincter complex. We propose a simple technique using the generally available transvaginal transducer to evaluate the anal sphincter complex. METHODS: Ninety-two patients underwent ultrasound examination. Group I consisted of 53 nulliparous patients. In Group II there were six patients with normal spontaneous vaginal deliveries without episiotomies. In Group III there were 14 patients with vaginal deliveries and one to three episiotomies but no lacerations. In Group IV there were nine postpartum patients with recently repaired (48 h to 3 weeks) third- and fourth-degree lacerations. All women in Groups I-IV were asymptomatic. Group V consisted of 10 patients symptomatic for fecal incontinence. We used a vaginal probe (5-9-MHz) with the footprint placed in the fourchette pointing towards the anus in a transverse and then in a median (sagittal) plane. If seen, the combined internal and external anal sphincter thickness at the 12 o'clock location was measured. We visualized normal star-shaped mucosal folds on the transverse section and described the sonographic anatomy in both planes. RESULTS: The mean sphincter thickness measured at 12 o'clock in Group I was 2.3 (range, 1.0-4.7) mm, in Group II it was 2.9 (range, 2.4-3.4) mm, and in Group III it was 2.3 (range, 1.0-3.7) mm. The differences between these three groups were not significant. Patients from Group IV showed thinning or discontinuous sphincter anatomy at the 12 o'clock position. All symptomatic patients from Group V showed abnormal sphincter anatomy, and the normal star-like appearance of the anal mucosa on the transverse section was deformed, radiating from the point of the sphincter damage. Four of the 10 patients in this group underwent surgical repair. In these patients the sonographic findings were confirmed. CONCLUSIONS: The images obtained using this imaging modality show the sphincter muscle anatomy as well as the possible pathology. Due to its simplicity the technique can be applied in any place where a vaginal transducer is available
— id: 56338, year: 2005, vol: 25, page: 177, stat: Journal Article,

The complexity of a "complex mass" and the simplicity of a "simple cyst"
Timor-Tritsch, Ilan E; Goldstein, Steven R
2005 Mar;24(3):255-258, Journal of ultrasound in medicine
— id: 76494, year: 2005, vol: 24, page: 255, stat: Journal Article,

Three-dimensional inversion rendering: a new sonographic technique and its use in gynecology
Timor-Tritsch, Ilan E; Monteagudo, Ana; Tsymbal, Tanya; Strok, Irina
2005 May;24(5):681-688, Journal of ultrasound in medicine
OBJECTIVE: The purpose of this presentation is to describe the use of the 3-dimensional (3D) sonographic inversion rendering mode in displaying fluid-filled structures using dedicated hardware and software in gynecology. METHODS: The 3D software used inverts anechoic into echogenic voxels, which, against the black background of the monitor screen, display the fluid-filled structure as a 'cast' of it. The technique of the rendering process is described. Three-dimensional sonographic volumes of the adnexal area in 3 patients thought to have adnexal or ovarian masses were stored and rendered with the use of the laptop version of the inversion software. The same process was used in an additional 12 women for various indications: 7 with suspected uterine malformations and 5 with uterine bleeding. Of these 12 women, 11 underwent saline infusion sonohysterography. RESULTS: Rendering the inverted fluid-filled adnexal structures revealed that, in all 3 cases, they were tubal, not ovarian, in origin (chronic hydrosalpinges). Of the 7 uterine cavities suspected of malformation, 3 were normal and 4 had uterine malformations: 2 arcuate uteri and 2 incomplete septate uteri. Of the 4 woman with dysfunctional uterine bleeding, 3 had endometrial cavities with polyps and 1 had an irregular surface of the cast. One woman with postmenopausal spotting had an enlarged but otherwise normal cavity. CONCLUSIONS: After a relatively short learning curve to master the inversion rendering technique, it is possible to use it in a selected number of gynecologic cases with fluid-filled structures. In resolving the correct diagnosis of the adnexal masses, the inversion images performed better than the 2-dimensional (2D) and 3D orthogonal planes. For diagnosis of uterine disease, the inversion pictures presented marginal value over the 2D and 3D images. The 3D inversion rendering technique may have added value in selected gynecologic cases, establishing a more accurate diagnosis somewhat faster than only 2D sonography or even the 3D orthogonal planes
— id: 56120, year: 2005, vol: 24, page: 681, stat: Journal Article,

Combined sonographic and endoscopic umbilical cord occlusion in twin and triplet gestations
Young, Bruce K; Stephenson, Courtney D; Mackenzie, Andrew P; Roman, Ashley S; Rebarber, Andrei; Minior, Victoria K; Mayberry, Patricia; Timor-Tritsch, Ilan E
2005 ;33(6):530-533, Journal of perinatal medicine
OBJECTIVE: To review our experience with a minimally invasive technique for umbilical cord occlusion as a method of selective feticide in monochorionic sets. STUDY DESIGN: Umbilical cord occlusion was completed using 3 mm bipolar cautery under ultrasound guidance (3D/4D, n = 6; 2D, n = 6) with pre and post ligation endoscopic evaluation. RESULTS: 12 cases of monochorionic sets where selective feticide was performed were identified during the period 2000 to present. There were four triplet and eight twin gestations in the study cohort. Median interval from intervention to delivery was 16 weeks (range, 5-19). All co-twins survived the procedure and 15 of 16 were delivered after 33 weeks. CONCLUSIONS: Umbilical cord occlusion in monochorionic sets can be accomplished in a minimally invasive manner with combined endoscopic and ultrasound guidance in both twin and triplet pregnancies
— id: 62605, year: 2005, vol: 33, page: 530, stat: Journal Article,

Early pregnancy origins of spontaneous preterm delivery
Bukowski, R; Hankins, GD; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Saade, GR; Eddleman, K; Gross, S; Dugoff, L; Hobbins, JC; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; Tibbetts, N; Hanson, JW; D'Alton, ME
2004 FEB ;11(2):206A-207A, Journal of the Society for Gynecologic Investigation
— id: 46676, year: 2004, vol: 11, page: 206A, stat: Journal Article,

First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial)
Dugoff, Lorraine; Hobbins, John C; Malone, Fergal D; Porter, T Flint; Luthy, David; Comstock, Christine H; Hankins, Gary; Berkowitz, Richard L; Merkatz, Irwin; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Steven R; Wolfe, Honor M; Vidaver, John; D'Alton, Mary E
2004 Oct;191(4):1446-1451, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications. STUDY DESIGN: Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies. RESULTS: Women with pregnancy-associated plasma protein A of < or =5th percentile were significantly more likely to experience spontaneous fetal loss at < or =24 weeks of gestation, low birth weight, preeclampsia, gestational hypertension, preterm birth ( P < .001) and stillbirth, preterm premature rupture of membranes, and placental abruption ( P < .02). Nuchal translucency at > or =99th percentile and free-beta subunit human chorionic gonadotropin at < or =1st percentile were associated with an increased risk of spontaneous loss at < or =24 weeks of gestation (adjusted odds ratios, 3.90, 3.62, respectively; P < .001). CONCLUSION: Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss
— id: 76495, year: 2004, vol: 191, page: 1446, stat: Journal Article,

Three-dimensional ultrasound to differentiate epigastric heteropagus conjoined twins from a TRAP sequence
MacKenzie, Andrew P; Stephenson, Courtney D; Funai, Edmund F; Lee, Men-Jean; Timor-Tritsch, Ilan
2004 Nov;191(5):1736-1739, American journal of obstetrics & gynecology
Twin reversed arterial perfusion sequence and epigastric heteropagus conjoined twins may appear similar antenatally. Three-dimensional ultrasound evaluated the relationship of a completely formed fetus and an adjacent second body consisting of a pelvis with 2 lower extremities, confirming the final diagnosis when two-dimensional ultrasound was unsuccessful. Three-dimensional ultrasound is useful in diagnosing epigastric heteropagus conjoined twins
— id: 47790, year: 2004, vol: 191, page: 1736, stat: Journal Article,

Quadruplet pregnancy: two sets of twins, each occupying a horn of a septate (complete) uterus
Monteagudo, Ana; Strok, Irina; Greenidge, Suzanne; Timor-Tritsch, Ilan E
2004 Aug;23(8):1107-1111, Journal of ultrasound in medicine
— id: 48072, year: 2004, vol: 23, page: 1107, stat: Journal Article,

First-trimester diagnosis of sacrococcygeal teratoma: the role of three-dimensional ultrasound
Roman, A S; Monteagudo, A; Timor-Tritsch, I; Rebarber, A
2004 Jul;23(6):612-614, Ultrasound in obstetrics & gynecology
A fetus was suspected of having a sacrococcygeal teratoma (SCT) on routine nuchal translucency evaluation by sonography at 12+3 weeks. The patient was referred for three-dimensional (3D) sonography to further delineate the extent of the mass. In this case, real-time scanning of the mass in 3D mode assisted the diagnosis of the mass and patient counseling. We present what we believe to be the first case of SCT imaged in the first trimester using 3D ultrasound
— id: 46115, year: 2004, vol: 23, page: 612, stat: Journal Article,

Neuroecografia prenatal y neonatal = Ultrasonography of the prenatal and neonatal brain
Timor-Tristch, Ilan E; Monteagudo, Ana; Cohen, Harris L
Madrid, Espana : Marban, 2004,
— id: 1992, year: 2004, vol: , page: , stat: ,

Sharp-angled lumbosacral kyphosis
Timor-Tritsch, Ilan E
2004 Oct;23(10):1378-1378, Journal of ultrasound in medicine
— id: 76496, year: 2004, vol: 23, page: 1378, stat: Journal Article,

Qualified and trained sonographers in the US can perform early fetal anatomy scans between 11 and 14 weeks
Timor-Tritsch, Ilan E; Bashiri, Asher; Monteagudo, Ana; Arslan, Alan A
2004 Oct;191(4):1247-1252, American journal of obstetrics & gynecology
OBJECTIVES: The objective of this study was to determine the extent to which normal fetal anatomy can be detected between 11- and 14-week scan by sonographers in the US. STUDY DESIGN: In a prospective cross-sectional study, 223 unselected women underwent a detailed assessment of fetal anatomy at 11 to 13 and 6/7 weeks by sonographers with transabdominal and/or transvaginal transducers. Thirty-seven structures were examined. Two groups were identified: group I: 121 patients between 11 and 12 weeks, and group II: 102 patients between 13 and 14 weeks. RESULTS: Structures other than the posterior fossa, heart, genitalia, and the sacral spine were seen between 64% to 99% for group I, and 72% to 98% for group II. The following structures were detected with statistically significantly higher rates in group II compared with group I: cerebellum, posterior fossa, face, 4-chamber view left ventricular outflow tract, aortic arch, ductal arch, kidneys, and genitalia. Comparing the patients of group I and group II, the transvaginal scans yielded a higher detection rate of structures than do the transabdominal scans. CONCLUSION: Anatomic surveys between 11 and 14 weeks can be performed by sonographers with good detection rates of most structures. Using the vaginal probe compared with the abdominal probe improved the detection rate at 13 to 14 weeks as well as 11 to 12 weeks. If early fetal structure evaluation is to become customary in the US, the present practice of experienced and trained sonographers to scan such patients can be maintained
— id: 47830, year: 2004, vol: 191, page: 1247, stat: Journal Article,

Two hundred ninety consecutive cases of multifetal pregnancy reduction: comparison of the transabdominal versus the transvaginal approach
Timor-Tritsch, Ilan E; Bashiri, Asher; Monteagudo, Ana; Rebarber, Andrei; Arslan, Alan A
2004 Dec;191(6):2085-2089, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of this study was to compare the performance of the transabdominal versus the transvaginal route for the multifetal pregnancy reductions. STUDY DESIGN: Two hundred ninety consecutive cases of multifetal pregnancy reduction were reviewed. Two hundred three reductions (70.0%) were done transabdominally; 75 cases (25.9%) were done transvaginally, and 12 cases (4.1%) used both routes. The indications for the transvaginal route were extreme obesity, abdominal scars, or if the lower fetus could not be reached transabdominally. Two hundred seventy-one women were delivered of live born babies after 24 weeks (group 1). Nineteen cases had pregnancy losses </=24 weeks (group 2). RESULTS: The complete pregnancy loss rate was 6.5% (19/290 cases). Total pregnancy loss rates of multifetal pregnancy reduction were 3.5% (7/203 reductions) for the transabdominal route and 13.3% (10/75 reductions) for the transvaginal route ( P = .004). Overall pregnancy losses were 4.8% for starting with twins, 6.6% for starting with triplets, 1.8% for starting with quadruplets, 14.3% for starting with quintuplets, and 14.3% with starting numbers of >/=6 fetuses. For finishing numbers, total pregnancy losses were 5.1% for ending with a singleton infant, 6.6% for ending with twins, and 0% for ending with triplets. Significant differences in complete pregnancy loss were observed between transabdominal and transvaginal routes for starting with triplets (2.7% for transabdominal versus 16.7% for transvaginal; P = .006) and for finishing with a single fetus (0% for transabdominal versus 20% for transvaginal; P < .004). CONCLUSION: The multifetal pregnancy reduction success rate was higher with the transabdominal route compared with the transvaginal route. Significant differences in favor of the transabdominal route were observed for starting with triplets or finishing with a single fetus. The transvaginal route should be reserved only for cases in which the transabdominal approach is hard or impossible to perform. The performance of the procedure at 12 to 13 weeks of gestation enables structural evaluation of the fetuses before reduction
— id: 48048, year: 2004, vol: 191, page: 2085, stat: Journal Article,

Effect of antenatal placental insufficiency on postnatal preterm infant gastrointestinal function
Wachtel, E; Hendrics-Munoz, K; Timor, I
2004 APR ;55(4):486A-486A, Pediatric research
— id: 46536, year: 2004, vol: 55, page: 486A, stat: Journal Article,

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study
Weiss, Joshua L; Malone, Fergal D; Vidaver, John; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Timor-Tritsch, Ilan E; D'Alton, Mary E
2004 Mar;190(3):745-750, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome. STUDY DESIGN: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used. RESULTS: The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6). CONCLUSION: First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding
— id: 76497, year: 2004, vol: 190, page: 745, stat: Journal Article,

Endoscopic closure of fetal membrane defects: comparing iatrogenic versus spontaneous rupture cases
Young, B K; Mackenzie, A P; Roman, A S; Stephenson, C D; Minior, V; Rebarber, A; Timor-Tritsch, I
2004 Oct;16(4):235-240, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: Currently, physicians manage preterm premature rupture of membranes (PPROM) by expectant management or termination of the gestation. A therapy aimed at sealing membranes would be optimal to maintain the pregnancy and achieve a normal neonate. Our objective was to compare an endoscopic technique for intrauterine closure of fetal membrane defects after both iatrogenic and spontaneous rupture of membranes. METHODS: Our technique was performed on four patients experiencing PPROM spontaneously and four patients after genetic amniocentesis. Intrauterine endoscopy allowed direct visualization of membrane defects. Rapid sequential injections of platelets, fibrin glue and powdered collagen slurry were administered at the site of the defect and of trocar placement. Sonography for amniotic fluid index, nitrazine and fern testing and pad count were performed after each procedure at three intervals: immediately post-procedure, and after 24 and 48 h. RESULTS: Eight patients underwent endoscopic intrauterine sealing of ruptured membranes between 16 and 24 weeks of gestation: four were spontaneous ruptures and four were ruptures post-amniocentesis. In the post-amniocentesis group, three patients delivered viable infants at 26, 32 and 34 weeks. In one patient, the membranes ruptured again 12 h after the sealing procedure and she decided to undergo termination of pregnancy. Of the four spontaneous rupture patients, two experienced preterm labor and delivery within 2 days of the procedure. One patient was diagnosed with fetal demise 12 h post-procedure, and one patient delivered a neonate at 31 weeks of gestation with severe respiratory distress syndrome. CONCLUSIONS: This technique for sealing ruptured membranes is effective after amniocentesis, but may not be of benefit with spontaneous rupture
— id: 55599, year: 2004, vol: 16, page: 235, stat: Journal Article,

The closure of iatrogenic membrane defects after amniocentesis and endoscopic intrauterine procedures
Young, Bruce K; Roman, Ashley S; MacKenzie, Andrew P; Stephenson, Courtney D; Minior, Victoria; Rebarber, Andrei; Timor-Tritsch, Ilan
2004 May-Jun;19(3):296-300, Fetal diagnosis & therapy
OBJECTIVE: To describe a new technique for wound closure after endoscopic intrauterine procedures which prevents amniotic fluid leakage after the procedure. STUDY DESIGN: This is an observational study which reviews a new technique under an IRB-approved protocol. The rationale for this study was the increasing frequency of intrauterine endoscopic procedures. The most common complication of these procedures is persistent leakage of amniotic fluid from puncture sites, which can result in preterm labor and preterm delivery. Thus, these procedures carry a high morbidity rate that may overcome the benefit of the intervention. We have employed a new technique, which has successfully prevented amniotic fluid leakage following the procedure. The instruments used for the endoscopic procedures were no larger than 3.5 mm for all cases. A sealant of platelets was rapidly injected followed by injection of fibrin glue and powdered collagen slurry at each puncture site. Sonography for modified AFI, clinical examination for nitrazine and ferning, and pad count were performed after each procedure at three intervals: immediately after the procedure, 24 h and 48 h. RESULTS: Eight patients undergoing an endoscopic intrauterine procedure (either cord ligation for twin-twin transfusion syndrome or sealing of ruptured membranes after amniocentesis) were included. All patients were treated between 18 and 24 weeks of gestation. Sonography, clinical examination and pad count revealed no evidence of amniotic fluid leakage either intra-abdominally or vaginally in any of the patients. There was 1 patient who ruptured membranes 12 h after the procedure due to severe vomiting. Another patient elected to terminate the pregnancy 48 h after the procedure without evidence of leakage. The remaining patients continued for 8 weeks or more without fluid leakage. CONCLUSION: The technique described, immediate sealing of puncture wounds following endoscopic intrauterine procedures, is effective in preventing amniotic fluid loss after the procedure
— id: 46087, year: 2004, vol: 19, page: 296, stat: Journal Article,

First-trimester origins of fetal growth impairment and its consequences - Results from the faster trial
Bukowski, R; Saade, G; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Hankins, GDV; Berkowitz, RL; Reingold, P; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; Tibbetts, N; D'Alton, ME
2003 DEC ;189(6):S76-S76, American journal of obstetrics & gynecology
— id: 42567, year: 2003, vol: 189, page: S76, stat: Journal Article,

Dating of pregnancy using last menstrual period, crown-rump length, or second-trimester ultrasound biometry: Results from the faster trial
Bukowski, R; Saade, G; Malone, FD; Porter, TF; Nyberg, DA; Comstock, CH; Hankins, GDV; Eddleman, K; Gross, S; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; Emig, D; D'Alton, ME
2003 DEC ;189(6):S134-S134, American journal of obstetrics & gynecology
— id: 42568, year: 2003, vol: 189, page: S134, stat: Journal Article,

First trimester anatomy scan: pushing the limits. What can we see now?
Monteagudo, Ana; Timor-Tritsch, Ilan E
2003 Apr;15(2):131-141, Current opinion in obstetrics & gynecology
PURPOSE OF REVIEW: The aim of this review article is to familiarize the reader with the current developments dealing with ultrasound during the first trimester of pregnancy. RECENT FINDINGS: The main emphasis of this article is to review the anatomy seen during the first trimester and to bring to the reader the fact that the first anatomical survey of the fetus does not have to wait until the 18th to 20th week of gestation. The fetus can be surveyed adequately as early as the 12th week of gestation and ideally between the 13th and 14th weeks. Of course, not all malformations will be detected during the first trimester, and a follow-up scan between 20 and 23 weeks is indicated. SUMMARY: The ongoing improvements in ultrasound technology allow us to see more details of the embryo or fetus at earlier gestational ages than ever before. This is resulting in a rethinking of when the first anatomical survey should be performed
— id: 39273, year: 2003, vol: 15, page: 131, stat: Journal Article,

Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) in triplet pregnancy after IVF and CVS
Shanske, Alan L; Pande, Sumati; Aref, Karim; Vega-Rich, Carlos; Brion, Luc; Reznik, Sandra; Timor-Tritsch, Ilan E
2003 Jun;67(6):467-471, Birth defects research. Pt. A. Clinical & molecular teratology
BACKGROUND: Omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is a rare sporadic condition. CASE: We identified an infant with major malformations resembling OEIS. He was the product of a 30-week triplet pregnancy conceived by in vitro fertilization (IVF) and evaluated by chorionic villi sampling (CVS). In this article, we review the possible pathogenetic mechanisms in this case, including IVF, multiple gestation, trauma to the uterus or uterine vessels following CVS, and placenta accreta. CONCLUSIONS: We conclude that the cumulative effects of all or some of these factors may have resulted in uteroplacental insufficiency adequate to produce this phenotype. This case provides additional evidence for the uterine vascular pathogenesis of OEIS complex in humans
— id: 62327, year: 2003, vol: 67, page: 467, stat: Journal Article,

Abnormal first-trimester fetal heart rate and pregnancy outcome: A population-based screening study (the faster trial)
Shevell, T; Malone, FD; Vidaver, J; Porter, TF; Luthy, DA; Comstock, CH; Bukowski, R; Eddleman, K; Gross, SJ; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2003 DEC ;189(6):S238-S238, American journal of obstetrics & gynecology
— id: 42571, year: 2003, vol: 189, page: S238, stat: Journal Article,

Assisted reproductive technology and pregnancy outcome - A population based screening study (the FASTER trial)
Shevell, T; Malone, FD; Vidaver, J; Porter, TF; Luthy, DA; Comstock, CH; Hankins, GD; Eddleman, K; Dolan, S; Dugoff, L; Craigo, SD; Timor, IE; Carr, SR; Wolfe, HM; D'Alton, ME
2003 DEC ;189(6):S175-S175, American journal of obstetrics & gynecology
— id: 42570, year: 2003, vol: 189, page: S175, stat: Journal Article,

Transrectal scanning: an alternative when transvaginal scanning is not feasible
Timor-Tritsch, I E; Monteagudo, A; Rebarber, A; Goldstein, S R; Tsymbal, T
2003 May;21(5):473-479, Ultrasound in obstetrics & gynecology
OBJECTIVE: In scanning the female pelvis the clear images of transvaginal sonography (TVS) result from placing the transducer close to the region of interest. The advantages of TVS over transabdominal sonography (TAS) and transperineal sonography are well documented. Transrectal scanning is proposed mostly for ultrasound guidance in draining a pelvic abscess. Our aim was to investigate the applicability of transrectal scanning (TRS) for cases in which TVS is impossible. METHODS: Forty-two patients with an absolute or a relative contraindication to TVS were scanned transabdominally and transrectally. The TRS was performed using a transvaginal probe, which was lubricated and slowly advanced into the rectum. The technique used was similar to that of TVS. Images were compared for resolution and quality. RESULTS: All scans were completed without significant patient discomfort or complaints. TRS was clearly superior to TAS in 31 cases. In nine cases TAS furnished some clinical information but TRS yielded better images. Only in one such case was TAS similar in quality to TRS. In four obese patients TAS did not reveal sufficient pelvic anatomy to generate a clinical diagnosis, whereas TRS revealed two sets of normal ovaries and two patients with ovarian cysts. In the two cases with vaginal agenesis TRS revealed the diagnosis of Rokitansky-Kuster syndrome. In three of the four patients with ruptured membranes the cervix could be measured precisely. CONCLUSION: Transrectal scanning should be used liberally after proper patient selection and counseling. The images obtained are superior to TAS and comparable to those obtained by TVS
— id: 76498, year: 2003, vol: 21, page: 473, stat: Journal Article,

Transvaginal ultrasound-assisted gynecologic surgery: evaluation of a new device to improve safety of intrauterine surgery
Timor-Tritsch, Ilan E; Masch, Rachel J; Goldstein, Steven R; Ng, Eliza; Monteagudo, Ana
2003 Oct;189(4):1074-1079, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of this study was to evaluate a new device that couples any standard transvaginal ultrasound transducer to a special tenaculum by means of a specially designed adaptor that enables real-time ultrasound imaging and guidance of intrauterine surgical procedures. STUDY DESIGN: Forty-five patients who underwent intrauterine surgical interventions were evaluated. Forty of these patients had pregnancy terminations. Three patients had curettage for early pregnancy complications. One patient had a polyp removed, and one patient underwent hysteroscopic submucous myomectomy. Five attending physicians performed 26 procedures. Four residents in training performed 19 procedures. All operators were instructed in the assembly and use of the device before their first procedure. Evaluation of the device was done by means of a detailed questionnaire. RESULTS: The procedures were completed successfully and without complications. The time that was involved for the various components of the surgical procedures was recorded; 83% to 90% of the time the operators felt that the technique increased safety and accuracy for the parameters that were evaluated. They required fewer intrauterine instrument manipulations; in 85% of the cases, they could detect the exact end point of the procedure more accurately. In 12% of cases, the operators felt that the device interfered with the performance of the procedure. CONCLUSIONS: The transvaginal ultrasound-assisted gynecological surgery system provided high-resolution images of the cervical canal and the uterine cavity during all stages of the procedure and provided improved indication of the procedure's end point. The increased safety and accuracy that was reported by most users was encouraging. The transvaginal ultrasound-assisted gynecologic surgery system appears to provide an enhanced alternative to transabdominal ultrasound guidance for intrauterine surgical procedures
— id: 38995, year: 2003, vol: 189, page: 1074, stat: Journal Article,

Magnetic resonance imaging versus ultrasound for fetal central nervous system abnormalities
Timor-Tritsch, Ilan E; Monteagudo, Ana
2003 Oct;189(4):1210-1211, American journal of obstetrics & gynecology
— id: 62124, year: 2003, vol: 189, page: 1210, stat: Journal Article,

Four-dimensional real-time sonographically guided cauterization of the umbilical cord in a case of twin-twin transfusion syndrome
Timor-Tritsch, Ilan E; Rebarber, Andrei; MacKenzie, Andrew; Caglione, Christopher F; Young, Bruce K
2003 Jul;22(7):741-746, Journal of ultrasound in medicine
In the past decade, three-dimensional (3D) sonographic technology has matured from a static imaging modality to near-real-time imaging. One of the more notable improvements in this technology has been the speed with which the imaged volume is acquired and displayed. This has enabled the birth of the near-real-time or four-dimensional (4D) sonographic concept. Using the 4D feature of the current 3D sonography machines allows us to follow moving structures, such as fetal motion, in almost real time. Shortly after the emergence of 3D and 4D technology as a clinical imaging tool, its use in guiding needles into structures was explored by other investigators. We present a case in which we used the 4D feature of our sonographic equipment to follow the course and motion of an instrument inserted into the uterus to occlude the umbilical cord of a fetus in a case of twin-twin transfusion syndrome
— id: 39141, year: 2003, vol: 22, page: 741, stat: Journal Article,

Evaluation of endometrial polyps
Goldstein, Steven R; Monteagudo, Ana; Popiolek, Dorota; Mayberry, Pat; Timor-Tritsch, Ilan
2002 Apr;186(4):669-674, American journal of obstetrics & gynecology
OBJECTIVE: Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and sonohysterography. The reported incidence of malignancy is low. The potential benefit of a noninvasive technique to distinguish benign from malignant polyps is obvious. This study was undertaken to evaluate endometrial polyps by color flow Doppler ultrasound scanning and histopathologic examination. STUDY DESIGN: This was an observational study of patients with an endometrial polyp on sonohysterography who underwent interrogation of their polyp with color Doppler ultrasound scanning and subsequently polypectomy. Polyp volume, resistive index, pulsatility index, indication for scan (bleeding vs incidental), and patient age were correlated with histopathologic type of the polyp (nonfunctional, proliferative, secretory, hyperplastic, or malignant). RESULTS: Of 61 patients studied, 42 patients (68.9%) were scanned for abnormal bleeding, and 19 patients (31.1%) had their polyps discovered incidentally. There were no statistically significant differences between histologic categories and the resistive index, pulsatility index, or size of the polyp. The age of patients with nonfunctional polyps was significantly greater than any other group (P <.001). Ninety-four percent of the functional polyps were discovered because of abnormal bleeding; 38% of the nonfunctional polyps were discovered incidentally (P <.001). CONCLUSION: The data suggest that the objective assessment of blood flow impedance (resistive index, pulsatility index) in endometrial polyps and the size of these polyps cannot replace surgical removal and pathologic evaluation to predict histologic type. Patients with nonfunctional polyps were older and less likely to have vaginal bleeding
— id: 39671, year: 2002, vol: 186, page: 669, stat: Journal Article,

First-trimester nuchal translucency screening
Malone, FD; Ball, RH; Berkowitz, RL; Bianchi, DW; Carr, SR; Comstock, CH; Craigo, SD; D'Alton, ME; de la Cruz, F; Dugoff, L; Gross, SJ; Hankins, GD; Hobbins, JC; Merkatz, IR; Nyberg, DA; Saade, GR; Timor-Tritsch, IE; Wolfe, HM
2002 APR ;21(4):481-483, Journal of ultrasound in medicine
— id: 98260, year: 2002, vol: 21, page: 481, stat: Journal Article,

Sirenomelia sequence: first-trimester diagnosis with both two- and three-dimensional sonography
Monteagudo, Ana; Mayberry, Patricia; Rebarber, Andrei; Paidas, Michael; Timor-Tritsch, Ilan E
2002 Aug;21(8):915-920, Journal of ultrasound in medicine
OBJECTIVE: To describe the sonographic findings of sirenomelia during the first trimester on both two-dimensional sonography with color Doppler imaging and three-dimensional sonography. METHODS: Two cases of sirenomelia in primiparous patients with histories of infertility are described. The diagnosis was made on the basis of two-dimensional sonography, and three-dimensional sonography was used to further characterize the findings. RESULTS: Both fetuses had size-date discrepancies, increased nuchal translucency, large intra-abdominal vessels, and 2-vessel umbilical cords. Both pregnancies were terminated by dilation and curettage after the patients viewed the three-dimensional pictures of the fetuses. CONCLUSIONS: During the first trimester of pregnancy, rare and lethal anomalies can be diagnosed with a high degree of confidence if a thorough, age-dependent anatomic survey of the fetus is performed
— id: 39416, year: 2002, vol: 21, page: 915, stat: Journal Article,

Real-time-dimensional U/S: the concept, the machines
Timor-Tritsch IE; Monteagudo A
2002 ;47:9-14 Apr 15, Contemporary ob/gyn
This promising new technology is already taking 3D ultrasound one step further into 'almost' real time. Once real-time 3D or 4D U/S is perfected, it will help clinicians study fetal behavior, take a closer look at fetal anomalies, perform 4D biopsies, and more
— id: 81365, year: 2002, vol: 47, page: 9, stat: Journal Article,

Three-dimensional ultrasound experience in obstetrics
Timor-Tritsch, Ilan E; Platt, Lawrence D
2002 Dec;14(6):569-575, Current opinion in obstetrics & gynecology
PURPOSE OF REVIEW: Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided. RECENT FINDINGS: The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays. SUMMARY: 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists
— id: 76499, year: 2002, vol: 14, page: 569, stat: Journal Article,

Ultrasonography of the prenatal and neonatal brain
Cohen, Harris L; Monteagudo, Ana; Timor-Tritsch, Ilan E
New York : McGraw-Hill, Health Professions Division, c2001,
— id: 731, year: 2001, vol: , page: , stat: ,

Improvement in outcomes of multifetal pregnancy reduction with increased experience
Evans, M I; Berkowitz, R L; Wapner, R J; Carpenter, R J; Goldberg, J D; Ayoub, M A; Horenstein, J; Dommergues, M; Brambati, B; Nicolaides, K H; Holzgreve, W; Timor-Tritsch, I E
2001 Jan;184(2):97-103, American journal of obstetrics & gynecology
OBJECTIVE: This study was undertaken to evaluate a decade of data on multifetal pregnancy reductions at centers with extensive experiences. STUDY DESIGN: A total of 3513 completed cases from 11 centers in 5 countries were analyzed according to year (before 1990, 1991-1994, and 1995-1998), starting and finishing numbers of embryos or fetuses, and outcomes. RESULTS: With increasing experience there has been a considerable improvement in outcomes, with decreases in rates of both pregnancy loss and prematurity. Overall loss rates in the last few years were correlated strongly with starting and finishing numbers (starting number > or =6, 15.4%; starting number 5, 11.4%; starting number 4, 7.3%; starting number 3, 4.5%; starting number 2, 6.2%: finishing number 3, 18.4%; finishing number 2, 6.0%; finishing number 1, 6.7%). Birth weight discordance between surviving twins was increased with greater starting number. The proportion of cases with starting number > or =5 diminished from 23.4% to 15.9% to 12.2%. The proportion of patients >40 years old increased in the last 6 years to 9.3%. Gestational age at delivery did not vary with increasing maternal age but was inversely correlated with starting number. CONCLUSION: Multifetal pregnancy reduction outcomes at our centers for both losses and early prematurity have improved considerably with experience. Reductions from triplets to twins and now from quadruplets to twins carry outcomes as good as those of unreduced twin gestations. Patient demographic characteristics continues to change as more older women use assisted reproductive technologies. In terms of losses, prematurity, and growth, higher starting numbers carry worse outcomes
— id: 76500, year: 2001, vol: 184, page: 97, stat: Journal Article,

First trimester cystic hygroma - A population based screening study (The FASTER Trial)
Malone, FD; Ball, RH; Nyberg, DA; Gross, SJ; Comstock, CH; Saade, GR; Eddleman, KA; Craigo, SD; Timor, IE; Carr, SR; Hobbins, JC; Dukes, KA; De la Cruz, F; D'Alton, ME
2001 DEC ;185(6):S99-S99, American journal of obstetrics & gynecology
— id: 55338, year: 2001, vol: 185, page: S99, stat: Journal Article,

Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar
Monteagudo A; Carreno C; Timor-Tritsch IE
2001 Oct;20(10):1105-1115, Journal of ultrasound in medicine
OBJECTIVE: To apply an existing diagnostic imaging test (saline infusion sonohysterography) to characterize the 'filling defect' of a previous cervical cesarean delivery scar in the nonpregnant uterus. METHODS: Forty-four patients with histories of cesarean delivery who underwent saline infusion sonohysterography for a variety of gynecologic indications were included. During the procedure, the area below the bladder recess was examined using transvaginal sonography. A filling defect or 'niche' was defined as a triangular anechoic structure at the presumed site of a previous cesarean delivery scar. The depth of the niche was measured. Uterine size, the presence of fibroids and polyps, and the number of previous cesarean deliveries were noted. RESULTS: All patients had a niche indenting the anterior uterine-cervical wall. The mean +/- SD depth of the niche was 6.17 +/- 3.6 mm. There was no correlation between the number of cesarean deliveries and the depth of the niche. Thirty-six percent of our patients had fibroids, and 18% had endometrial polyps. CONCLUSION: Saline infusion sonohysterography was able to detect filling defects in women who previously had cesarean deliveries. We hope that by focusing our attention on the transvaginal sonographic appearance of the detectable uterine scar (niche) with or without the use of saline infusion sonohysterography in the nonpregnant uterus, it will train our eyes to look for the scar in the pregnant uterus. In addition, our study patients had a high prevalence of abnormal uterine bleeding. The role of the cesarean delivery scar in women with unscheduled bleeding needs to be further evaluated
— id: 39479, year: 2001, vol: 20, page: 1105, stat: Journal Article,

Limb-body wall complex in triplet pregnancy after IVF and CVS
Shanske, AL; Pande, S; Aref, K; Vega-Rich, C; Reznik, S; Timor-Tritsch, IE
2001 OCT ;69(4):660-660, American journal of human genetics
— id: 54827, year: 2001, vol: 69, page: 660, stat: Journal Article,

Transvaginal sonographic evaluation of fetal anatomy at 14 to 16 weeks. Why is this technique not attractive in the United States
Timor-Tritsch IE
2001 Jul;20(7):705-709, Journal of ultrasound in medicine
— id: 21137, year: 2001, vol: 20, page: 705, stat: Journal Article,

Tubal ring and corpus luteum echogenicities
Timor-Tritsch IE
2001 Jul;20(7):802-802, Journal of ultrasound in medicine
— id: 63291, year: 2001, vol: 20, page: 802, stat: Journal Article,

Endoscopic ligation of umbilical cord at 19 week's gestation in monoamniotic monochorionic twins discordant for hypoplastic left heart syndrome
Young BK; Roque H; Abdelhak Y; Timor-Tristch I; Rebarber A; Rosen R
2001 Jan-Feb;16(1):61-64, Fetal diagnosis & therapy
We report the first attempt of reduction of monoamniotic twins, discordant for hypoplastic left heart syndrome, using a new fetoscopic technique. Employing sonographic guidance and endoscopic visualization, cord ligation was accomplished, but significant cord entanglement, not previously appreciated, resulted in the ligation of the umbilical cord of the normal fetus. Cord entanglement may frustrate endoscopic techniques in monoamniotic twins
— id: 26825, year: 2001, vol: 16, page: 61, stat: Journal Article,

Velamentous insertion of the cord in the first trimester
Monteagudo A; Sfakianaki AK; Timor-Tritsch IE
2000 Oct;16(5):498-499, Ultrasound in obstetrics & gynecology
— id: 21251, year: 2000, vol: 16, page: 498, stat: Journal Article,

Second- and third-trimester ultrasound evaluation of chorionicity and amnionicity in twin pregnancy. A simple algorithm
Monteagudo A; Timor-Tritsch IE
2000 Jun;45(6):476-480, Journal of reproductive medicine
OBJECTIVE: To develop a simple and systematic algorithm to determine chorionicity and amnionicity in the second and third trimester by ultrasound. STUDY DESIGN: The algorithm was constructed based upon years of experience in examining multifetal pregnancies and by adopting the different sonographic signs suggested in the literature. RESULTS: The following parameters were used to construct the algorithm: sexing of the fetuses, placental location, and origin, thickness and number of layers of the membranes. CONCLUSION: The flow chart developed is simple to use and embodies all possible sonographic parameters to help determine chorionicity and amnionicity in the second and third trimester
— id: 62320, year: 2000, vol: 45, page: 476, stat: Journal Article,

Three-dimensional transvaginal neurosonography of the fetal brain: 'navigating' in the volume scan
Monteagudo A; Timor-Tritsch IE; Mayberry P
2000 Sep;16(4):307-313, Ultrasound in obstetrics & gynecology
OBJECTIVES: Fetal neuroscan by ultrasound has gained in importance over recent years. Two-dimensional (2D) transvaginal sonography was an important step in understanding the constantly changing and developing fetal brain. The objective of this article is to describe the use of three-dimensional ultrasound of the fetal brain enhanced by the transvaginal transfontanelle scanning technique. METHODS: Thirty-four pregnant patients were referred to us because of a history of brain anomaly or suspected brain pathology. The fetuses were scanned transvaginally. Two-dimensional as well as three-dimensional (3D) images were generated. The volumes obtained by the 3D-ultrasound machine were displayed in the three conventional orthogonal planes (coronal, sagittal and axial). RESULTS: Of the 34 fetuses 10 had normal brain anatomy and 24 had brain pathology. In all 34 cases the 2D images as well as the 3D volumes were of diagnostic quality and all three planes could be obtained. The axial sections could only be obtained by the 3D re-construction of the volume scans. The 2D images produced were acquired from a common point originating from the foot print of the transvaginal probe at the fetal anterior fontanelle or the sagittal suture, the sections 'radiate' from this point. Therefore, these sections are not parallel sections, but are oblique to each other. In contrast, the 3D volume could be examined using the classical parallel sections in all three orthogonal planes. The posterior fossa could be seen better if the footprint of the probe was placed over the posterior fontanelle or on the sagittal suture. The marker dot enabled a precise creation of anatomy and pathology. In the 'angio mode' it was possible to follow the anterior cerebral and pericallosal artery. CONCLUSIONS: The 3D-ultrasound technology using the transvaginal approach is effective and practical to perform during fetal neuroscan. The ability to 'navigate' in the volume and the 'marker dot' enables exact location of normal structures and evaluation fetal brain pathology. The volume can be reviewed over and over again, can be mailed to an expert, could be shown to consultants (pediatric neurology and neurosurgeons) and used for teaching
— id: 21252, year: 2000, vol: 16, page: 307, stat: Journal Article,

Amniocentesis after multifetal pregnancy reduction: is it safe?
Stephen JA; Timor-Tritsch IE; Lerner JP; Monteagudo A; Alonso CM
2000 Apr;182(4):962-965, American journal of obstetrics & gynecology
OBJECTIVE: This report reviews the obstetric outcomes of women with multifetal pregnancy reductions who subsequently underwent elective amniocentesis. STUDY DESIGN: Five hundred eight patients underwent multifetal pregnancy reduction at our institution. Among these, 91 patients underwent subsequent elective amniocentesis. The obstetric outcomes of all 508 patients were followed up. By means of logistic regression we evaluated several variables to determine any association with loss rate: (1) the finishing number of fetuses, (2) the number of fetuses undergoing reduction (starting number of fetuses minus the finishing number of fetuses), (3) the gestational age at reduction, (4) the maternal age at reduction, and (5) the procedure protocol. We observed that the finishing number of fetuses, the number of fetuses removed, and the procedure protocol were significantly associated with pregnancy loss rate. Women who underwent subsequent amniocentesis were compared with those who did not undergo amniocentesis. By means of multivariate conditional likelihood analysis we stratified the two groups according to the previously mentioned significant variables to compare the pregnancy loss rates. RESULTS: Among patients who subsequently underwent elective amniocentesis the total uncorrected pregnancy loss rate was 9.0% and the early premature delivery rate was 4.5%. The number of fetuses removed, the finishing number of fetuses, and the procedure protocol were statistically significantly associated with the loss rate. The adjusted odds ratio relating amniocentesis to the pregnancy loss rate was 0.7 (95% confidence interval, 0.31.5; P =.3.) CONCLUSIONS:The uncorrected rates of pregnancy loss and of early premature delivery among patients with multifetal pregnancy reduction who underwent subsequent amniocentesis were comparable to those of patients with multifetal pregnancy reduction who did not undergo amniocentesis
— id: 62319, year: 2000, vol: 182, page: 962, stat: Journal Article,

Real-time spectral analysis of the fetal EEG: a new approach to monitoring sleep states and fetal condition during labor
Thaler, I; Boldes, R; Timor-Tritsch, I
2000 Sep;48(3):340-345, Pediatric research
Adverse perinatal events affecting cerebral functions are a major cause of neonatal mortality, morbidity, and long-term neurologic deficit. Intrapartum fetal EEG, which records fetal brain electrical activity, provides a monitoring modality for evaluating the fetal CNS during labor. In this study, we describe a new approach to such monitoring that is based on real-time spectral analysis of the fetal EEG during labor. Fourteen pregnant women with uncomplicated term pregnancies who went into labor participated in the study. Two suction-cup electrodes were applied to the fetal scalp at the occipitoparietal or parietal region after rupture of membranes. Real-time spectral analysis was used to determine the frequency and amplitude of the fetal EEG signal. The spectral edge frequency (SEF) was calculated as the frequency below which 90% of the power in the power spectrum resides. The average EEG amplitude and the SEF were displayed using the density spectral array technique. Fetal heart rate and intrauterine pressure were also measured. Two fundamental EEG patterns were identified: high-voltage slow activity and low-voltage fast activity. The SEF was found to be an excellent index of cyclic EEG activity. Fetal heart rate demonstrated increased variability and an elevated baseline during low-voltage fast activity, whereas both parameters decreased during high-voltage slow activity. During episodes of variable decelerations in the fetal heart rate, a decrease in the SEF was observed, accompanied by an increased EEG voltage. The results obtained substantiate the presence of sleep cycles in the human fetus. This kind of cortical activity monitoring may enable rapid alertness to cerebral hypoxia and allow for prompt intervention, thereby decreasing the risk for birth asphyxia and subsequent brain damage
— id: 76501, year: 2000, vol: 48, page: 340, stat: Journal Article,

Dichorionic triplet pregnancy with the monoamniotic twin pair concordant for omphalocele and bladder exstrophy
Timor-Tritsch IE; Monteagudo A; Horan C; Stangel JJ
2000 Dec;16(7):669-671, Ultrasound in obstetrics & gynecology
— id: 21250, year: 2000, vol: 16, page: 669, stat: Journal Article,

Three-dimensional ultrasound evaluation of the fetal brain: the three horn view
Timor-Tritsch IE; Monteagudo A; Mayberry P
2000 Sep;16(4):302-306, Ultrasound in obstetrics & gynecology
OBJECTIVE: To describe an easy technique for obtaining one of the most important views of the fetal brain and image. The entire lateral ventricle including the anterior, posterior and inferior horns is demonstrated on one image. We propose to call this view, obtained in an oblique plane 'the three horn view'. METHODS: Depending upon the scanning technique employed there are two ways to obtain the three horn view: (1) by two-dimensional (2D) transvaginal transfontanelle sonography obtained by using the left and right Oblique-1 sections, and (2) by three-dimensional (3D) imaging of the fetal brain, is obtained by acquiring a volume scan of the brain orienting the fetal head in the three main orthogonal planes and by rotating or tilting the midcoronal section to the left and right. RESULTS: To illustrate the technique of obtaining the three horn view four normal fetal brains were scanned. Two scans utilized the 2D transvaginal transfontanelle approach and two scans utilized the 3D scanning technique. The same technique was then applied to six fetuses with various brain malformations with inflicted changes in the shape of the proposed three horn view. CONCLUSION: The three horn view, depicting the anterior, posterior, and inferior horns on the same image, was easy to obtain using both the 2D and the 3D ultrasound techniques. It provided diagnostic and clinically useful information much like neonatal transfontanelle ultrasound imaging after which it was emulated
— id: 21253, year: 2000, vol: 16, page: 302, stat: Journal Article,

Color flow-directed Doppler studies of ovarian masses. Computer analysis
Levy, G; Levine, P; Brennan, J; Lerner, J P; Monteagudo, A; Timor-Tritsch, I E
1998 Oct;43(10):865-868, Journal of reproductive medicine
OBJECTIVE: To determine if analyzing the entire color Doppler image (CDI) pulse wave of an ovarian mass can improve the ability to predict its histopathology. STUDY DESIGN: The CDI of 42 histopathologically diagnosed adnexal masses were retrospectively analyzed. Using an image analysis software program, the following parameters were calculated: area under the curve, compactness, Feret diameter, perimeter, shape factor and width of the waveform. Using an automated curve-fitting software program, the up and down slopes were processed separately for the optimal equation and coefficient for each slope. Two computerized neural networks were created, both consisting of an input layer, one hidden layer and an output layer of three neurons: benign, borderline and malignant. The first network contained two input neurons: pulsatility index (PI) and resistance index (RI). The second network contained 10 input neurons consistent with the shape and slope parameters calculated. The coefficient of determination (R2) was determined for each network. RESULTS: The neural network utilizing RI and PI failed to train (1,397 runs, 67,056 facts, R2 = 0.59, 0.12 and 0.43 for benign, borderline and malignant masses, respectively). The network using the 10 calculated parameters achieved an R2 of 0.96 after 685 runs and 27 facts. CONCLUSION: Analyzing the CDI studies of ovarian masses, using the entire pulse wave, improved the ability to differentiate between their benign, borderline and malignant histopathology
— id: 76502, year: 1998, vol: 43, page: 865, stat: Journal Article,

Ultrasound and multifetal pregnancy
Monteagudo, Ana; Timor-Tritsch, Ilan E
New York NY : Parthenon Pub, 1998,
— id: 1991, year: 1998, vol: , page: , stat: ,

Transvaginal sonographic markers of tubal inflammatory disease
Timor-Tritsch IE; Lerner JP; Monteagudo A; Murphy KE; Heller DS
1998 Jul;12(1):56-66, Ultrasound in obstetrics & gynecology
OBJECTIVES: Since the introduction of transvaginal sonography (TVS), clear pictures of the female reproductive tract have been obtained. These images enable the accurate description of Fallopian tube pathology. However, the current literature on the ultrasound diagnosis of pelvic inflammatory disease (PID) is confusing and contradictory. The goal of our study was to identify sonographic markers of inflammatory disease of the pelvis and to place these in a clinical context. PATIENTS AND METHODS: Seventy-seven patients were scanned by TVS. They were divided into two groups, according to their clinical picture, the first group with acute PID and the second with a history of chronic PID or no history at all. The sonographic markers studied were shape, wall structure and wall thickness of the Fallopian tube. Ovarian involvement and the presence of pelvic fluid were also evaluated. RESULTS: The best marker of tubal inflammatory disease, either acute or chronic, was the presence of an incomplete septum of the tubal wall, which was present in 92% of the total cases. A thick wall and the 'cogwheel' sign were sensitive markers of acute disease, whereas a thin wall and 'beads-on-a-string' sign were indicators of chronic disease. Palpable findings and surgical history were not discriminatory, but were present in three-quarters and one-third of the study population, respectively. Three false-positive cases are presented: an ovarian cystadenoma, an appendiceal mucocele and one case with periovarian fluid accumulation. CONCLUSIONS: The tubo-ovarian complex and the tubo-ovarian abscess should be considered separate entities that differ in their clinical implications. TVS allows one to distinguish between them. Distinguishing characteristics of acute and chronic salpingitis are presented
— id: 7825, year: 1998, vol: 12, page: 56, stat: Journal Article,

Is it safe to use methotrexate for selective injection in heterotopic pregnancy?
Timor-Tritsch, I E
1998 Jan;178(1 Pt 1):193-194, American journal of obstetrics & gynecology
— id: 76504, year: 1998, vol: 178, page: 193, stat: Journal Article,

Fetal neurosonography
Timor-Tritsch, Ilan E; Monteagudo, Ana
Asphyxia and fetal brain damage New York NY : Wiley-Liss, 1998,
— id: 5246, year: 1998, vol: , page: ?, stat: Chapter,

Transvaginal gray-scale imaging of ureteral jets in the evaluation of ureteral patency
Haratz-Rubinstein, N; Murphy, K E; Monteagudo, A; Timor-Tritsch, I E
1997 Nov;10(5):342-345, Ultrasound in obstetrics & gynecology
We have previously reported on the value of transvaginal color Doppler evaluation of the ureteral jets to confirm ureteral patency. In this study, we attempt to validate the simple and widely available gray-scale ultrasound technique to perform the same task. Fifty consecutive patients without a history of urinary complaints were recruited. The presence or absence of the right and left ureteral jets was registered using gray-scale imaging, comparing the technique to color Doppler as the 'gold standard'. The time to the detection of the first jet as well as the total scanning time were documented for each side. The jets were seen with equal frequency on both the right and the left sides (34 observations each). In 24 patients, both jets were visualized. The median time to detection of the first jet was 47 s (range 34-79 s) for the right jet and 53 s (36-84 s) for the left jet (p = 0.42). The median total scanning time was 176 s (139-259 s). Gray-scale imaging was associated with a sensitivity of 68% and a positive predictive value of 100%. Although color Doppler results may be more attractive because of their impressive color-coded appearance, the major disadvantage of this technique is that it requires sophisticated and costly equipment. Transvaginal gray-scale imaging is a reliable and useful test for the detection of ureteral jets in the bladder. It can be used as a first-line diagnostic tool, particularly in settings where color Doppler is not available. Its benefits include safety, low cost, convenience and simplicity. With a positive predictive value of 100%, this test may be used in the postoperative patient, especially when ureteral patency is in question
— id: 76505, year: 1997, vol: 10, page: 342, stat: Journal Article,

Ovarian steroid cell tumors: sonographic characteristics
Monteagudo, A; Heller, D; Husami, N; Levine, R U; McCaffrey, R; Timor-Tritsch, I E
1997 Oct;10(4):282-288, Ultrasound in obstetrics & gynecology
The goal of the gynecologist is to detect ovarian tumors in their earliest stages. Small virilizing tumors, which barely affect the size of the ovaries, are such lesions. Since the introduction of transvaginal sonography it is technically possible to detect small intraovarian neoplasms. Three cases of virilizing steroid cell tumors in postmenopausal women with ovarian volumes just exceeding the normal sizes for age are presented. High-frequency transvaginal ultrasound and color Doppler studies to measure flow parameters were used. These small tumors had different echogenicity from the surrounding ovarian tissue and two had low impedance-to-flow values. Gray-scale transvaginal sonography combined with color Doppler studies can make the diagnosis of small steroid cell tumors easier and, at times, better than other, more costly imaging modalities
— id: 76506, year: 1997, vol: 10, page: 282, stat: Journal Article,

Development of fetal gyri, sulci and fissures: a transvaginal sonographic study
Monteagudo, A; Timor-Tritsch, I E
1997 Apr;9(4):222-228, Ultrasound in obstetrics & gynecology
We aimed to determine the feasibility of imaging specific sulci, gyri and fissures using transvaginal sonography and to correlate their first sonographic recognition with gestational age. Retrospectively, 262 fetal brain scans were analyzed from a total of 337 scans. Scans were selected if any of the following structures were seen: in the coronal plane the lateral, callosal and cingulate sulcus and gyrus; in the median plane the parieto-occipital and calcarine fissures, and the cingulate gyrus and sulcus; and, in an oblique section, the lateral sulcus. The gestational age at which the fissures, sulci and gyri were first imaged was recorded and subsequently compared with similar anatomical studies from the literature. It was possible to identify all the targeted structures. The gestational ages at which the structures were first imaged were: the callosal sulcus, from 14 weeks; the lateral sulcus, from 18 weeks; the parieto-occipital sulcus and calcarine fissure, from 18 weeks; and the cingulate gyrus, from 26 weeks. We concluded that the developmental maturation of the normal fetal brain follows a predictable timetable, and that this maturation can be grossly followed with sonography. The sonographic recognition of the fissures, gyri and sulci lagged behind the observations by anatomical studies. The greatest discrepancy was the first appearance of the cingulate gyrus which, in the anatomical studies, could be seen by 18 postmenstrual weeks and, in our study, was seen after 26 postmenstrual weeks. The one exception was the callosal sulcus, which was first seen at 14 postmenstrual weeks in both the sonographic and anatomical studies. In conclusion, the recognition of specific structures of the cortical map is possible. Sonography may be used to image the developing cortical surface
— id: 76508, year: 1997, vol: 9, page: 222, stat: Journal Article,

Accurate diagnosis of postabortal placental remnant by sonohysterography and color Doppler sonographic studies
Tal, J; Timor-Tritsch, I; Degani, S
1997 ;43(2):131-134, Gynecologic & obstetric investigation
The decision whether to perform uterine curettage for postabortal bleeding depends on the ability to demonstrate placental remnants in the uterine cavity. However, diagnosis of postabortal trophoblastic residua by conventional ultrasonography may be inconclusive. We report our experience with the use of combined sonohysterography and color Doppler to demonstrate a placental polyp after early pregnancy termination
— id: 76509, year: 1997, vol: 43, page: 131, stat: Journal Article,

Monochorionic quadramniotic quadruplets: sonographic workup
Timor-Tritsch, I E; Fleischer, A; Monteagudo, A; Valderrama, E
1997 Nov-Dec;12(6):363-367, Fetal diagnosis & therapy
OBJECTIVE: We raise the issue of scanning multifetal pregnancies of higher order as early as possible. A rare case of monochorionic/quadramniotic pregnancy seeking multifetal pregnancy reduction and its clinical management is presented. METHODS: Transabdominal scanning at 16 weeks was performed correctly diagnosing the monochorionic quadruplet pregnancy. RESULTS: Suspecting vascular connections between the placentae, the fetal reduction was declined. The patient was delivered at 31 weeks. The 4 female neonates survived with slight ventilatory assistance. CONCLUSION: Multifetal pregnancies in general, but those of higher order in particular, have to be scanned as early as 8-10 weeks to correctly and easily assign their chorionicity and amnionicity. The case of a monochorionic/quadramniotic pregnancy and its clinical course are presented
— id: 76503, year: 1997, vol: 12, page: 363, stat: Journal Article,

Transvaginal color Doppler sonography of the ureteral jets: a method to detect ureteral patency
Timor-Tritsch, I E; Haratz-Rubinstein, N; Monteagudo, A; Lerner, J P; Murphy, K E
1997 Jan;89(1):113-117, Obstetrics & gynecology
OBJECTIVE: To evaluate the feasibility of the detection of ureteral jets into the bladder in obstetric-gynecologic patients using transvaginal color Doppler ultrasound. METHODS: Fifty-two women were recruited and categorized into four groups: 1) 20 normal nonsurgical, 2) 17 post-cesarean delivery, 3) 12 post-total abdominal hysterectomy, and 4) three with only one functional kidney or ureter. In the first three groups, transvaginal color Doppler sonography was used to evaluate the time to detection of the first jet and the number of jets in 5 minutes bilaterally. In the last group, the presence or absence of the jet was documented only on the functional side. Statistical analysis was performed using Student t test and analysis of variance followed by Tukey honestly significant difference. RESULTS: Urine jets could be detected bilaterally in all women except for those with only one functional kidney (accuracy 100%). Time to detection of the first jet did not differ significantly in the nonsurgical, cesarean, or hysterectomy patients on either the right side (P = .07) or the left side (P = .43). The total number of jets was similar in the nonsurgical and cesarean patients, but was significantly lower in the hysterectomy group (right side P = .006; left side P = .004). In the women with one functional kidney, the normal side was identified in all cases. CONCLUSION: Transvaginal color Doppler sonography is a simple, accurate technique that can be used to evaluate ureteral jets into the bladder in women. The length of time to detection of the first jet is not affected by the postoperative status. Fewer jets should be expected in women who have undergone hysterectomies. This method should be used when ureteral integrity is in question, especially after surgery
— id: 76510, year: 1997, vol: 89, page: 113, stat: Journal Article,

Interfetal heart rate and size variation in first-trimester multifetal pregnancies and heart rate of surviving fetuses after fetal reduction
Zimmer, E Z; Chao, C R; Sharma, S; Timor-Tritsch, I E
1997 Apr;9(4):253-256, Ultrasound in obstetrics & gynecology
The objective of this study was to determine the variation in first-trimester fetal size and fetal heart rates in multifetal pregnancies, and to study the effect of fetal reduction on the surviving fetal heart rate. Fetal crown-rump length and fetal heart rates were measured in 44 patients with multifetal pregnancies who underwent fetal reduction. The heart rates of the surviving fetuses were also measured immediately after, and 1 h following the procedure. A total of 143 fetuses were evaluated prior to reduction and 75 fetuses following the procedure. There was no significant difference in crown-rump length between fetuses of the same gestation. The interfetal fetal heart rate variation between fetuses of the same gestation, expressed as a standard deviation, was 4.78 +/- 0.51 beats/min (mean standard deviation +/- standard error of the mean) before reduction; this was a significantly greater variation than could be attributed to error in the measurement of heart rate. In the surviving fetuses, the mean heart rate did not change. However, immediately after the reduction, interfetal heart rate variation was abolished, but was observed again 1 h after the reduction. We conclude that in first-trimester multifetal pregnancies (1) there is no significant difference in fetal crown-rump length; (2) there is interfetal variation in heart rates; and (3) fetal reduction has only a limited effect on the heart rates of surviving fetuses
— id: 76507, year: 1997, vol: 9, page: 253, stat: Journal Article,

Ultrasonography of the prenatal and neonatal brain
Cohen, Harris L; Monteagudo, Ana; Timor-Tritsch, Ilan E
Stamford, Conn. : Appleton & Lange, c1996,
— id: 692, year: 1996, vol: , page: , stat: ,

International, collaborative experience of 1789 patients having multifetal pregnancy reduction: a plateauing of risks and outcomes
Evans, M I; Dommergues, M; Wapner, R J; Goldberg, J D; Lynch, L; Zador, I E; Carpenter, R J Jr; Timor-Tritsch, I; Brambati, B; Nicolaides, K H; Dumez, Y; Monteagudo, A; Johnson, M P; Golbus, M S; Tului, L; Polak, S M; Berkowitz, R L
1996 Jan-Feb;3(1):23-26, Journal of the Society for Gynecologic Investigation
OBJECTIVE: To develop the most up-to-date, complete data base of multifetal pregnancy reduction (MFPR) from cases, and to provide the best counseling for couples with multifetal pregnancies. METHODS: From nine centers in five countries, 1789 completed MFPR cases were collected and outcomes evaluated. Pregnancy losses were defined as through 24 weeks and deliveries categorized in groups of 25-28, 29-32, 33-36, and 37 or more weeks. RESULTS: Overall, the pregnancy loss rate was 11.7% but varied from a low of 7.6% for triplets to twins and increased with each additional starting number to 22.9% for sextuplets or higher. Early premature deliveries (25-28 weeks) were 4.5% and varied with starting number. Loss rates by finishing number were highest for triplets and lowest for twins, but gestational age at delivery was highest for singletons. CONCLUSIONS: Multifetal pregnancy reduction has been shown to be a safe and effective method to improve outcome in multifetal pregnancies. Outcomes are worse with higher-order gestations and support the need for continued vigilance of fertility therapy
— id: 76523, year: 1996, vol: 3, page: 23, stat: Journal Article,

Prenatal diagnosis of the split hand anomaly: how early is early?
Haratz-Rubinstein, N; Yeh, M N; Timor-Tritsch, I E; Monteagudo, A
1996 Jul;8(1):57-61, Ultrasound in obstetrics & gynecology
A case of split hand anomaly detected by transvaginal sonography at 18 weeks of gestation is reported in which the diagnosis was difficult to establish. Different aspects of this pathology are discussed. Sonographic diagnosis of hand anomalies may be difficult to establish, even with experience. The ideal timing for the prenatal detection of this anomaly remains to be determined
— id: 76514, year: 1996, vol: 8, page: 57, stat: Journal Article,

Use of transvaginal sonography in the evaluation of endometrial hyperplasia and carcinoma
Lerner, J P; Timor-Tritsch, I E; Monteagudo, A
1996 Dec;51(12):718-725, Obstetrical & gynecological survey
Published studies relating to the use of transvaginal sonography (TVS) in the evaluation of endometrial hyperplasia and carcinoma were reviewed. Approximately 80 percent of all curettage procedures performed for postmenopausal bleeding result in benign diagnoses, therefore, if a noninvasive modality such as TVS can be accurately used to determine endometrial thickness measurements below which pathology is less likely, sampling may be avoided. The largest study evaluating endometrial measurements in postmenopausal women with bleeding, known as the Nordic trial, found that for a cut-off value of < or = 4 mm, 96 percent sensitivity and 68 percent specificity was achieved. Another study evaluated endometrial echomorphology in addition to measurement and found that the combined approach improved the predictability of pathologic findings. TVS may also be used to assess the depth of myometrial invasion in patients already diagnosed histologically with endometrial carcinoma. Although MRI is considered the established tool in the presurgical evaluation of the patient with carcinoma, TVS was found to perform only slightly less accurately than MRI. The published studies regarding TVS and/or MRI are reviewed. Finally, the use of TVS in conjunction with a new modality, sonohysterography, in the evaluation of patients on tamoxifen therapy, is discussed. Although the published cut-off values for endometrial thickness measurements do not apply to this group of patients, a procedure whereby sterile saline is injected into the uterine cavity, via a thin catheter, provides additional information regarding endometrial contours. Once the procedure is performed, the supposed complex endometrial echo seen on TVS is often found to actually be located in the subendometrial myometrium and the endometrium itself is thin and regular. The role for TVS is well established in the search for endometrial hyperplasia and carcinoma, as well as evaluating the presence of myometrial invasion once the diagnosis is made
— id: 76512, year: 1996, vol: 51, page: 718, stat: Journal Article,

Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy
Monteagudo, A; Tarricone, N J; Timor-Tritsch, I E; Lerner, J P
1996 Dec;8(6):381-386, Ultrasound in obstetrics & gynecology
Cervical pregnancy is a rare type of ectopic pregnancy. A recurrent cervical pregnancy in conjunction with a viable intrauterine pregnancy is an even rarer event. We present a case in which a recurrent cervical pregnancy was treated by selective reduction using an injection of potassium chloride guided by transvaginal sonography. The intrauterine gestation was delivered at a gestation of 34 weeks and 4 days by Cesarean section. Subsequently, the patient was treated with intramuscular methotrexate with a prolonged, but complete, resolution of the cervical pregnancy
— id: 76511, year: 1996, vol: 8, page: 381, stat: Journal Article,

Autosomal dominant cataracts of the fetus: early detection by transvaginal ultrasound
Monteagudo, A; Timor-Tritsch, I E; Friedman, A H; Santos, R
1996 Aug;8(2):104-108, Ultrasound in obstetrics & gynecology
Cataracts are lens opacities that account for approximately 10% of blindness in children. We report on four consecutive pregnancies in a woman at risk for recurrent autosomal dominant cataracts in which extensive ultrasound studies were helpful in establishing the correct diagnosis. The normal appearance of the fetal lens is that of a ring with a central sonolucency, but in cases of cataracts the lens appears hyperechogenic to various degrees. In the first pregnancy, normal lenses were seen at 15 postmenstrual weeks and, at birth, the baby girl had normal lenses. In the second pregnancy, the male fetus was affected by a left-sided cataract and a right-sided anophthalmia which were diagnosed at 16 postmenstrual weeks. The histological examination of the specimen from the aborted fetus correlated with the sonographic diagnosis. The third pregnancy, also a male fetus, had bilateral cataracts suspected at 14 weeks, but the final diagnosis was made at 19 weeks and confirmed at 21 weeks. The couple opted to terminate the pregnancy and the histology confirmed the presence of congenital cataracts. In the fourth pregnancy, we diagnosed asymmetry of the orbital sizes and bilateral cataracts at 15 weeks. In conclusion, the diagnosis of fetal cataract from the second trimester of pregnancy is possible and imaging of the fetal lenses should be part of the routine anatomical survey. Since the exact onset of fetal cataracts is uncertain at present, in cases at risk, serial sonograms may be indicated
— id: 76513, year: 1996, vol: 8, page: 104, stat: Journal Article,

Age and the ovarian follicle pool assessed with transvaginal ultrasonography
Ruess, M L; Kline, J; Santos, R; Levin, B; Timor-Tritsch, I
1996 Feb;174(2):624-627, American journal of obstetrics & gynecology
OBJECTIVE: We tested whether transvaginal ultrasonography could detect the age-related decrease in follicle counts that has been observed in autopsy studies. STUDY DESIGN: Thirty-one healthy volunteers in three age groups (22 to 25, 30 to 33, and 39 to 42 years) underwent ultrasonography in the follicular and luteal phases of the menstrual cycle. At the conclusion of the study the 124 ovarian scans were randomly ordered and antral follicles > or = 2 mm were counted by an evaluator unaware of age. Ordinary least-squares linear regression was used to estimate the associations of age with the total antral follicle count and with ln (1 + follicle count). RESULTS: The numbers of antral follicles > or = 2 mm decreased by about 60% between 22 and 42 years. Age-related decreases were similar for both phases of the cycle and held for both smaller (2 to 3.5 mm) and larger (>3.5 mm) follicles. CONCLUSION: We hypothesize that ultrasonographically derived counts of follicles provide a measure of reproductive age that may help to predict age-related phenomena
— id: 76522, year: 1996, vol: 174, page: 624, stat: Journal Article,

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993
Tal, J; Haddad, S; Gordon, N; Timor-Tritsch, I
1996 Jul;66(1):1-12, Fertility & sterility
OBJECTIVE: To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies. DATA IDENTIFICATION: Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993. CONCLUSIONS: The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future
— id: 76517, year: 1996, vol: 66, page: 1, stat: Journal Article,

Can a "snapshot" sagittal view of the cervix by transvaginal ultrasonography predict active preterm labor?
Timor-Tritsch, I E; Boozarjomehri, F; Masakowski, Y; Monteagudo, A; Chao, C R
1996 Mar;174(3):990-995, American journal of obstetrics & gynecology
OBJECTIVE: Our purpose was to test the hypothesis that wedging of the cervical internal os determined by transvaginal ultrasonography is associated with premature labor and delivery. STUDY DESIGN: Seventy patients admitted to the hospital for threatened preterm labor were evaluated by transvaginal ultrasonography before institution of therapy. Bivariate and logistic regression analyses were performed to determine the variables that made a significant contribution to the prediction of preterm delivery. RESULTS: Preterm delivery was significantly associated with the presence of cervical wedging, as noted on cervical scan, and with short cervical length. A history of previous preterm delivery was of marginal significance as a predictor of preterm delivery (p=0.09). Preterm delivery was not significantly correlated with age, previous voluntary termination of pregnancy, gestational age at the time of study, previous normal spontaneous vaginal delivery, or tocolytic therapy. Use of wedging as a diagnostic test for the prediction of preterm delivery yielded a sensitivity of 100% a specificity of 74.5%, a positive predictive value of 59.4%, and a negative predictive value of 100%. CONCLUSION: The presence of wedging and shorter cervical length was suggestive of true preterm labor requiring aggressive management. A transvaginal ultrasonographic 'snapshot' view of the cervix seems to be a more reliable method to evaluate the cervix in patients with threatened premature labor than are uterine contractions alone
— id: 72463, year: 1996, vol: 174, page: 990, stat: Journal Article,

Exencephaly-anencephaly sequence: proof by ultrasound imaging and amniotic fluid cytology
Timor-Tritsch, I E; Greenebaum, E; Monteagudo, A; Baxi, L
1996 Jul-Aug;5(4):182-185, Journal of maternal-fetal medicine
We present and discuss major current theories about the developmental natural history of the anencephalic human fetus. We confirm previous observations made using transvaginal ultrasonography of exencephalic fetuses which were later imaged and/or delivered as anencephalic fetuses. We explore the possibility of proving the theory of the slowly rubbed-off exposed brain tissue by cytologic examination and special staining of aspirated cells in amniotic fluid. Three fetuses with a typical sonographic picture of exencephaly at 13-15 postmenstrual weeks underwent amniocentesis. The aspirated fluid contained pathognomonic neural cells. The same fetuses later showed the characteristic sonographic and postabortion picture of anencephaly. Our results support the theory that exencephaly is the forerunner of anencephaly
— id: 76516, year: 1996, vol: 5, page: 182, stat: Journal Article,

Scanning techniques in obstetrics and gynecology
Timor-Tritsch, I E; Monteagudo, A
1996 Mar;39(1):167-174, Clinical obstetrics & gynecology
Using the appropriate scanning techniques and knowing the advantages and disadvantages of ultrasound equipment, the clinically useful pictures that enable better care of the obstetric and gynecologic patient can be generated. The extra advantage of applying the best possible scanning technique may enable the clinician or the imaging specialist to arrive at the correct diagnosis, despite problems created by anatomic circumstances, such as body habitus. The widespread use of ultrasound in general and transvaginal sonography in particular substantially has changed obstetric and gynecologic practice. High frequency transducer probes enable the creation of a crisp detailed picture that facilitates a more accurate and faster diagnostic procedure. Transvaginal sonography should be considered the first choice laboratory tool in the diagnosis of an increasing number of obstetric and gynecologic entities
— id: 76521, year: 1996, vol: 39, page: 167, stat: Journal Article,

Transvaginal fetal neurosonography: standardization of the planes and sections by anatomic landmarks
Timor-Tritsch, I E; Monteagudo, A
1996 Jul;8(1):42-47, Ultrasound in obstetrics & gynecology
Owing to the limited mobility of the transvaginal probe within the vagina and the introitus, it is virtually impossible to obtain coronal and sagittal sections that are anatomically comparable to those obtained in anatomic sections, computed tomography or magnetic resonance scanning. The aim of this paper is to standardize the neurosonographic images of the fetal brain and develop a nomenclature that more closely reflects the true anatomic sections. A retrospective review of 347 fetal neuroscans was performed. With the use of specific landmarks within the fetal brain, new nomenclature was developed. The scans were divided into the frontal, coronal and sagittal groups. Each group was subsequently further divided into three specific sections. The transvaginal sonographic images of the fetal brain radiate in a fan-like fashion from the anterior fontanelle; therefore the new proposed nomenclature more accurately describes the true anatomic sections
— id: 76515, year: 1996, vol: 8, page: 42, stat: Journal Article,

Transvaginal sonographic detection of adducted thumbs, hydrocephalus, and agenesis of the corpus callosum at 22 postmenstrual weeks: the masa spectrum or L1 spectrum. A case report and review of the literature
Timor-Tritsch, I E; Monteagudo, A; Haratz-Rubinstein, N; Levine, R U
1996 Jun;16(6):543-548, Prenatal diagnosis
Prenatal diagnosis of non-chromosomal syndromes relies, among others, on the detection of specific morphological findings. In rare syndromes the index case may not be prenatally diagnosed but subsequent pregnancies may benefit from early diagnosis. In this article we discuss the clinical spectrum of an X-linked hereditary disease which contains hydrocephalus, congenital agenesis of the corpus callosum, adducted thumbs, shuffling gait, aphasia, mental retardation, and at times other associated findings. The purpose of this case report is to describe the prenatal sonographic findings of a fetus affected with adducted thumbs, hydrocephaly, and agenesis of te corpus callosum. The patient was referred at 22 1/2 weeks' gestation for prenatal diagnosis. Ultrasound revealed a male fetus with dilatation of the lateral ventricles and partial agenesis of the corpus callosum. The fetal hands showed the thumbs to be fixed in a flexed-adducted position. These findings were consistent with the MASA spectrum (mental retardation-aphasia-shuffling gait-adducted thumbs) present in the older brother. The patient elected to terminate the pregnancy and autopsy confirmed the sonographic findings. In conclusion, prenatal sonography, especially the presence of adducted thumbs, allowed prenatal diagnosis of the second affected child with the MASA spectrum in this family. This morphology-based approach becomes feasible between postmenstrual weeks 15 and 20. Prior to this gestational age, the diagnosis should rely on molecular biology tests
— id: 76519, year: 1996, vol: 16, page: 543, stat: Journal Article,

A 'potentially safer' route for puncture and injection of cornual ectopic pregnancies
Timor-Tritsch, I E; Monteagudo, A; Lerner, J P
1996 May;7(5):353-355, Ultrasound in obstetrics & gynecology
Puncture and injection (usually by methotrexate) of ectopic pregnancies are relatively new modalities of treatment. Lately, these have been applied to cornual ectopic pregnancies. We describe here a proposed transvaginal ultrasound-guided puncture route, leading the needle into the cornual ectopic pregnancy, first traversing the myometrium and approaching the gestational sac from the medical aspect. After extracting the needle, there is potentially less chance for rupture and bleeding. In six of the seven injected cornual pregnancies, this technique was used without complication. The only one punctured from the lateral aspect bled and required laparoscopic intervention. This technique may enable the wider use of this treatment modality by lowering the complication rate caused by bleeding at the puncture site
— id: 76520, year: 1996, vol: 7, page: 353, stat: Journal Article,

Ultrasound-guided transvaginal procedures
Timor-Tritsch, I E; Monteagudo, A; Lerner, J P
1996 Jun;8(3):200-210, Current opinion in obstetrics & gynecology
Transvaginal ultrasound revolutionized the practice of obstetrics and gynecology in the past decade. Its 'port of entry' was its application in the diagnostic, as well as the technical and therapeutic aspects, in the reproductive aspects of infertility. This review summarizes the advances made by the continual improvement of equipment, and the ingenious use of different punctures guided by transvaginal sonography in the important area of reproductive technologies
— id: 76518, year: 1996, vol: 8, page: 200, stat: Journal Article,

Ultrasound in gynecology
Goldstein, Steven R.; Timor-Tritsch, Ilan E
New York : Churchill Livingstone, 1995,
— id: 517, year: 1995, vol: , page: , stat: ,

Characterization of placenta accreta using transvaginal sonography and color Doppler imaging
Lerner, J P; Deane, S; Timor-Tritsch, I E
1995 Mar;5(3):198-201, Ultrasound in obstetrics & gynecology
The safe use of transvaginal sonography in patients with placenta previa has been confirmed, and has revolutionized precise placental localization. The aim of our study was to evaluate the efficacy of transvaginal sonography and color-coded blood flow in the prediction of placenta accreta. Twenty-one patients with persistent placenta previa were scanned using transvaginal sonography and color-coded flow. Suspicion for placenta accreta consisted of total placenta previa at term with several placental lacunae exhibiting marked or turbulent blood flow, as seen with color Doppler transvaginal sonography from within the placenta, extending into the surrounding tissues. Five of the patients exhibited sonographic placental patterns suspicious for placenta accreta and one patient exhibited placental and cervical blood flow described as lacunar. Five Cesarean hysterectomies were performed for placenta accreta. Every placenta accreta was correctly diagnosed sonographically by the use of color flow studies. One patient with suspicion of placenta accreta delivered at another institution, a Cesarean hysterectomy was performed, and the pathology was confirmed. The one placenta previa exhibiting turbulent lacunar flow in the cervical area only was not confirmed to be an accreta at Cesarean section, although hemostasis was difficult at the placental bed. The remaining 15 patients with placenta previa and who on sonography were not suspicious for placenta accreta underwent uncomplicated Cesarean section. Transvaginal sonography and color Doppler imaging improve the diagnostic accuracy in the prediction of placenta accreta in patients with persistent placenta previa. A pattern of turbulent blood flow extending from the placenta into the surrounding tissues should alert the physician to the possibility of placenta accreta
— id: 76526, year: 1995, vol: 5, page: 198, stat: Journal Article,

The psychological effects of multifetal pregnancy reduction
McKinney, M; Downey, J; Timor-Tritsch, I
1995 Jul;64(1):51-61, Fertility & sterility
OBJECTIVE: To study the psychological effects of multifetal pregnancy reduction. DESIGN AND SETTING: Hour-long semistructured telephone interviews with both multifetal pregnancy reduction patients and control subjects. PATIENTS: Forty-two multifetal pregnancy reduction patients were contacted within 1 year of undergoing the procedure. Forty-four control subjects had become pregnant after infertility evaluation or treatment but conceived only a single fetus or twins and thus did not consider fetal termination. MAIN OUTCOME MEASURES: Standardized measures of depressive disorder and current psychiatric symptoms, as well as questions about emotional reactions to multifetal pregnancy reduction. RESULTS: Reduction patients who were pregnant or postpartum at the time of the interview (n = 34) were no more likely than pregnant or postpartum controls (n = 34) to report episodes of depression or high psychiatric symptom levels. The same proportion (14.7%) of both reduction patients and controls with a successful pregnancy outcome met criteria for an episode of major depressive disorder occurring during the 9 months before the interview. In contrast, the 8 reduction patients who spontaneously aborted the entire pregnancy and the 10 controls who spontaneously aborted reported significantly higher rates of the full depressive syndrome. CONCLUSIONS: Multifetal pregnancy reduction is experienced as stressful and distressing. However, when pregnancy outcome is successful, the medical intervention does not put women at significant risk for affective illness or elevated levels of psychiatric symptoms
— id: 76524, year: 1995, vol: 64, page: 51, stat: Journal Article,

Sonographic neuroembryology of the central nervous system
Monteagudo, A; Tharakan, T; Timor-Tritsch, I E
1995 ;6(1):34-37, Journal of the Association for Academic Minority Physicians
In the last decade, strong emphasis has been placed on the structural evaluation of the fetus. Central nervous system anomalies are among the most common malformations affecting the developing fetus. As ultrasound equipment has improved, our demand for more resolute pictures has increased. The high-frequency, transvaginal ultrasound probe allows us to access the fetal fontanel and produce high-resolution fetal brain images. When such transducer probes are aligned with the fetal anterior fontanel (much like neonatal brain scans), clear and clinically useful images in the sagittal and coronal planes are generated. In this article, we review the technique of transvaginal transfontanel scanning, discuss pertinent neuroembryology, and apply this information to the sonographic diagnosis of neural tube defects
— id: 76527, year: 1995, vol: 6, page: 34, stat: Journal Article,

Transvaginal ultrasonography in the office: the eye on the finger of the gynecologist
Timor-Tritsch, I E
1995 May;172(5):1639-1639, American journal of obstetrics & gynecology
— id: 76525, year: 1995, vol: 172, page: 1639, stat: Journal Article,

Fetal breathing characteristics and postnatal outcome in cases of congenital diaphragmatic hernia
Badalian, S S; Fox, H E; Chao, C R; Timor-Tritsch, I E; Stolar, C J
1994 Oct;171(4):970-976, American journal of obstetrics & gynecology
OBJECTIVE: Our purpose was to determine characteristics of fetal breathing activity by recording fetal nasal fluid flow velocity in cases of congenital diaphragmatic hernia. STUDY DESIGN: Fetal breathing-related nasal fluid flow was studied in 47 patients at 34 to 41 weeks of gestation, 16 cases of antenatally diagnosed congenital diaphragmatic hernia and 31 cases of uncomplicated pregnancy. The examination was performed by ultrasonography combined with color-flow and spectral Doppler analysis. An average of 25 breath cycles from each case was determined for each of the following timing parameters: breath-to-breath interval, time of inspiration, time of expiration, and ratio of time of inspiration and time of expiration. RESULTS: In all cases with uncomplicated pregnancy fetal breathing-related nasal fluid flow was seen at the level of the nose, and the timing components of this flow were determined as control values. In two cases with diaphragmatic hernia no perinasal flow was demonstrated, although fetal breathing movements observed as chest wall movements were present. The other 14 cases with congenital diaphragmatic hernia who demonstrated perinasal flow had the following postnatal outcome: one stillbirth, five neonatal deaths (group I), and eight survived and were discharged (group II). The study revealed that the time of expiration (in milliseconds) in group II (493.2 +/- 34.3 SEM) was significantly (p = 0.0030) shorter than in group I (653.4 +/- 38.4) and in cases of uncomplicated pregnancy (633.6 +/- 18.5). The value of the time of inspiration/time of expiration ratio in group II was approximately 15% higher than in group I and approximately 30% higher than in cases of uncomplicated pregnancies. CONCLUSIONS: Observation of fetal breathing-related nasal fluid flow velocity in cases of antenatally diagnosed congenital diaphragmatic hernia provides a rationale for the hypothesis that time of expiration and the time of inspiration/time of expiration ratio may be useful in the prediction of postnatal outcome. We speculate that the changes in the group of survivors may represent a compensatory phenomenon by causing intermittent changes in the volume of fluid within the lungs
— id: 76528, year: 1994, vol: 171, page: 970, stat: Journal Article,

Transvaginal ultrasonographic evaluation of the cervix before labor: presence of cervical wedging is associated with shorter duration of induced labor
Boozarjomehri, F; Timor-Tritsch, I; Chao, C R; Fox, H E
1994 Oct;171(4):1081-1087, American journal of obstetrics & gynecology
OBJECTIVE: Our purpose was to test the hypothesis that transvaginal ultrasonographically determined characteristics of the cervix are associated with duration of induced labor. STUDY DESIGN: Fifty-three patients scheduled for induction of labor underwent transvaginal ultrasonography and digital cervical examinations before labor induction. Cox proportional-hazards multiple regression analysis was performed to determine the variables that made a significant contribution to the prediction of latent-phase and total labor duration. In the analysis the possible confounding effects of exogenous prostaglandin, previous vaginal delivery, and previous termination of pregnancy were controlled. RESULTS: Latent-phase and total labor duration were significantly associated with the presence of cervical wedging noted on transvaginal ultrasonography and administration of prostaglandin but not with the result of digital examination of cervical effacement or dilatation. Latent-phase duration was also associated with cervical length measured by transvaginal ultrasonography. The presence of wedging was significantly associated with shorter latent (15.9 +/- 1.7 vs 34.1 +/- 3.8 hours, p = 0.0001) and total (22.0 +/- 1.8 vs 38.3 +/- 3.6 hours, p = 0.0001) labor length. CONCLUSION: The presence of wedging and decreased cervical length observed by transvaginal ultrasonography is associated with a shorter duration of induced labor and may be useful in the evaluation of induction candidates
— id: 72464, year: 1994, vol: 171, page: 1081, stat: Journal Article,

Transabdominal versus transcervical and transvaginal multifetal pregnancy reduction: international collaborative experience of more than one thousand cases
Evans, M I; Dommergues, M; Timor-Tritsch, I; Zador, I E; Wapner, R J; Lynch, L; Dumez, Y; Goldberg, J D; Nicolaides, K H; Johnson, M P
1994 Mar;170(3):902-909, American journal of obstetrics & gynecology
OBJECTIVES: Two major approaches for multifetal pregnancy reduction have been developed over the past several years: transabdominal potassium chloride by injection and pelvic procedures by either transcervical aspiration or transvaginal potassium chloride injection or by an automated spring-loaded puncture device. The purpose of this study was to create the largest database from among the world's largest centers to assess possible differences in efficacy and complication rates by transabdominal or transcervical or multifetal pregnancy reduction. STUDY DESIGN: Data on over 1000 completed pregnancies that underwent multifetal pregnancy reduction by both methods from major centers with among the highest worldwide experience were combined. Transabdominal cases were divided temporally (1986 through 1991 and 1991 through 1993). RESULTS: Transabdominal multifetal pregnancy reduction was successfully performed on 846 patients and transcervical or transvaginal on 238 patients. Transcervical or transvaginal reduction is performed earlier and starts and finishes with fewer embryos. In 12.6% of cases transcervical or transvaginal reduction left a singleton as opposed to 4.4% for transabdominal reduction. Pregnancy losses (up to 24 weeks) were observed in 13.1% of transcervical or transvaginal cases and in 16.2% of transabdominal cases early in the series and 8.8% of late transabdominal cases. Transcervical or transvaginal reduction may be safer very early in gestation and transabdominal safer later in the first trimester. Premature deliveries were comparable, with only about 5% delivered between 25 and 28 weeks. The smaller starting numbers for transcervical and transvaginal reduction may explain a slightly higher term delivery rate. The transabdominal route tends to reduce the fundal embryos and the transcervical and transvaginal the lower ones. The significance of this is not clear. CONCLUSIONS: (1) Multifetal pregnancy reduction by either method is a relatively safe and efficient method for improving outcome in multifetal pregnancies. (2) More than 84% are delivered at > 33 weeks. (3) The experience and preference of the operator are probably the key determinants for an individual patient. (4) An inverse relationship of starting and finishing number to loss rates and gestational age at delivery suggests that there still is a cost of iatrogenic multifetal pregnancies, even if multifetal pregnancy reduction can be successfully performed
— id: 76533, year: 1994, vol: 170, page: 902, stat: Journal Article,

Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system
Lerner, J P; Timor-Tritsch, I E; Federman, A; Abramovich, G
1994 Jan;170(1 Pt 1):81-85, American journal of obstetrics & gynecology
OBJECTIVE: The aim of the study was to modify a previously devised morphologic scoring system with the use of transvaginal ultrasonography in the hope of improving discrimination of benign from malignant ovarian and adnexal masses. STUDY DESIGN: Transvaginal ultrasonographic images of 312 patients for a total of 350 ovarian and adnexal masses were obtained over a 3-year period. The derived morphologic data were analyzed by multiple linear regression analysis to select the best performance of the previously described scoring system by Sassone et al. in 1991. This system was thus modified in several ways including weighted point value assignments, fewer point values per variable studied, the deletion of one variable found not to be significant (wall thickness), and the inclusion of a new variable called shadowing. RESULTS: At surgery, 308 benign masses, 31 malignant masses, and 11 tumors of low malignant potential were found. The mean point value obtained was 1.8 for the benign masses, 3.9 for the tumors of low malignant potential, and 5.6 for the malignant tumors (p < 0.0005). With a cutoff of > or = 3 used as the best discriminator, the sensitivity was 96.8% and the specificity 77%. The positive and negative predictive values were 29.4% and 99.6%, respectively. CONCLUSION: Limitations of the previously devised scoring system included the arbitrary point assignments of each variable, the multiple (4 or 5) point choices for each variable, and the poor positive predictive value. This new scoring system performs well in the differentiation of benign from malignant masses, while assigning scientifically derived, therefore more valid, point values and simplifying the system overall. That the positive predictive value was not improved proves that ultrasonographically, to date we are still hampered by complex and malignant-appearing benign ovarian masses
— id: 76536, year: 1994, vol: 170, page: 81, stat: Journal Article,

An approach to multifetal pregnancy reduction in a pregnancy of grand order (12 fetuses)
Monteagudo, A; Timor-Tritsch, I E
1994 Jul 1;4(4):339-341, Ultrasound in obstetrics & gynecology
Our objective was to determine the best method to approach a multifetal pregnancy reduction of a patient with a multiple pregnancy of grand order (12 fetuses). Transvaginal ultrasound-guided reduction was performed in three stages. Successful outcome was achieved. The patient delivered twins at 37 weeks' gestation. The published and unpublished literature is reviewed and discussed in the light of this case. Our conclusion is that a multifetal pregnancy reduction of grand order can be performed in stages to achieve the desired number of fetuses
— id: 76530, year: 1994, vol: 4, page: 339, stat: Journal Article,

In utero detection of ventriculomegaly during the second and third trimesters by transvaginal sonography
Monteagudo, A; Timor-Tritsch, I E; Moomjy, M
1994 May 1;4(3):193-198, Ultrasound in obstetrics & gynecology
The purpose of this study was two-fold. The first was to extend the previously developed and published nomograms of the fetal lateral ventricles from 18 weeks back to 14 weeks of gestation using transvaginal sonography, and, second, to test the performance of the nomograms by plotting the measurements of 36 fetuses whose transabdominal and/or qualitative transvaginal scans were suspicious for ventriculomegaly. In all the cases in which postnatal confirmation of the diagnosis was possible, prenatal ultrasound correctly identified the lesion. Although a total of nine nomograms was created, the clinically meaningful measurements were: the height of the occipital horn on the parasagittal plane, and the two ratios derived from the measurements performed on the parasagittal plane. In conclusion, the transvaginally generated nomograms were useful for the correct identification of fetuses with ventriculomegaly
— id: 76531, year: 1994, vol: 4, page: 193, stat: Journal Article,

Early and simple determination of chorionic and amniotic type in multifetal gestations in the first fourteen weeks by high-frequency transvaginal ultrasonography
Monteagudo, A; Timor-Tritsch, I E; Sharma, S
1994 Mar;170(3):824-829, American journal of obstetrics & gynecology
OBJECTIVE: Our aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at > or = 14 weeks' gestation. STUDY DESIGN: Two hundred twelve multifetal pregnancies were scanned transvaginally at or before 14 weeks' gestation. The number of fetuses and the chorionic and amniotic type were determined ultrasonographically. Of the 212 patients, 54 were delivered at our institution, and 43 of these 54 had pathologic evaluation of the placenta. Ultrasonographic and pathologic correlation of the chorionic and amniotic type was assessed in this group. RESULTS: Ultrasonographic evaluation of the 212 pregnancies demonstrated 64 twin, 87 triplet, 41 quadruplet, 18 quintuplet, 1 sextuplet, and 1 septuplet gestation. Nine of the twin pregnancies were monochorionic-diamniotic; two of the triplets were dichorionic-triamniotic, and four of the quadruplets were trichorionic-quadraamniotic. In the 43 patients with both ultrasonographic and pathologic assessment, there were 40 twins, five of which were monochoronic diamniotic type. All three triplets were trichorionic-triamniotic type. In all 43 transvaginal ultrasonography correctly predicted the chorionic and amniotic type as determined by the pathologic findings. CONCLUSIONS: Transvaginal ultrasonography at < or = 14 weeks can easily and accurately determine the chorionic and amniotic type in multifetal pregnancies
— id: 76534, year: 1994, vol: 170, page: 824, stat: Journal Article,

Transvaginal ultrasonographic findings in surgically verified ectopic pregnancy
Timor-Tritsch, I
1994 Apr;170(4):1205-1206, American journal of obstetrics & gynecology
— id: 76532, year: 1994, vol: 170, page: 1205, stat: Journal Article,

New technologies in obstetrics and gynecology: the test of time
Timor-Tritsch, I E; Condrea, A
1994 Sep 1;4(5):355-357, Ultrasound in obstetrics & gynecology
— id: 76529, year: 1994, vol: 4, page: 355, stat: Journal Article,

Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography
Timor-Tritsch, I E; Monteagudo, A; Mandeville, E O; Peisner, D B; Anaya, G P; Pirrone, E C
1994 Mar;170(3):737-739, American journal of obstetrics & gynecology
We evaluated the feasibility of transvaginal methotrexate injection of viable cervical pregnancies to avoid complications of the 'classic' surgical procedures in use and to preserve future fertility. Five viable cervical pregnancies, at 6 to 8 weeks, were treated. In three patients a spring-loaded automated puncture device and in two a manually operated simple needle guide mated to and guided by a transvaginal ultrasonography probe were used with 21-gauge needles. The puncture and injection treatment was successful and without complications in all five cases presented. This procedure may become a useful alternative to other, more radical or complex surgical approaches
— id: 76535, year: 1994, vol: 170, page: 737, stat: Journal Article,

Transvaginal sonographic characterization combined with cytologic evaluation in the diagnosis of ovarian and adnexal cysts
Yee, H; Greenebaum, E; Lerner, J; Heller, D; Timor-Tritsch, I E
1994 ;10(2):107-112, Diagnostic cytopathology
A transvaginal sonographic (TVS) scoring system using morphologic features has been developed at our institution to maximize discrimination between benign and malignant ovarian and adnexal cysts. Low (4-7) or intermediate (8-9) scores have been found to correlate with benignity, hence TVS-guided or laparoscopically directed needle aspiration of low-scoring lesions may safely be performed. High-scoring lesions (10-14) are often malignant, therefore in situ needle aspiration of such lesions is not recommended. The aim of our study was to correlate the results of TVS characterization of ovarian and adnexal cysts with the aspiration cytologic evaluation. Twenty-three of the 43 cysts studied were aspirated in situ from the patient; 20 were aspirated from resected surgical specimens. Thirty-six benign cysts had TVS scores ranging from 4 to 12, with a median score of 7. All 25 cysts that were benign by TVS and/or histology were also cytologically benign as well as an additional 11 cysts that were not resected (TVS scores: 4 to 9). Seven cytologically and histologically malignant cysts had high TVS scores (TVS scores 10-14; median = 12). The combination of TVS and needle aspiration cytology is valuable, particularly in the diagnosis of cysts having low or intermediate TVS scores and benign cytology. Aspiration of cysts or masses with high TVS scores is not recommended. This combined evaluation may allow a more limited surgical approach, such as operative laparoscopy, or, in some cases, obviate the need for operative treatment altogether
— id: 76537, year: 1994, vol: 10, page: 107, stat: Journal Article,

Fetal breathing-related nasal fluid flow velocity in uncomplicated pregnancies
Badalian, S S; Chao, C R; Fox, H E; Timor-Tritsch, I E
1993 Sep;169(3):563-567, American journal of obstetrics & gynecology
OBJECTIVE: Our purpose was to determine the Doppler ultrasonographic characteristics of fetal breathing-related nasal fluid flow velocity in uncomplicated pregnancies. STUDY DESIGN: Fetal nasal flow velocity was studied in 52 uncomplicated pregnancies at gestational ages ranging from 22 to 41 weeks. The evaluation of fetal breathing-related nasal fluid flow velocity was performed with ultrasonography combined with color flow and spectral Doppler analysis. RESULTS: The study revealed that the breath-to-breath interval and duration of the inspiratory phase of the fetal breathing-related nasal flow increased from 22 to 35 weeks and decreased thereafter. The breath-to-breath interval (milliseconds) at 33 to 35 weeks (1203.9 +/- 295.7 SD) was approximately twice what it was in the earliest age group (22 to 25 weeks); subsequently it decreased by approximately 25% in the term group (38 to 41 weeks). A positive correlation existed between the mean breathing-related nasal peak inspiratory flow velocity and advancing gestational age (r = 0.56, p = 0.0008), and between the inspiratory flow velocity acceleration and advancing gestational age (r = 0.53, p = 0.0076). CONCLUSION: Changes in fetal breathing activity during uncomplicated pregnancies can be determined by measurement of fetal breathing-related nasal fluid flow velocity. Our observations in uncomplicated pregnancies may be useful in future studies of these parameters in complicated pregnancies such as those at risk for pulmonary hypoplasia
— id: 76539, year: 1993, vol: 169, page: 563, stat: Journal Article,

Fetal upper respiratory tract function in cases of antenatally diagnosed congenital diaphragmatic hernia: preliminary observations
Fox, H E; Badalian, S S; Timor-Tritsch, I E; Marks, F; Stolar, C J
1993 May 1;3(3):164-167, Ultrasound in obstetrics & gynecology
Fetal upper respiratory tract function was studied in five cases of antenatally diagnosed congenital diaphragmatic hernia and in 16 cases of uncomplicated pregnancy at gestational ages ranging from 27 to 38 weeks. The evaluation of fetal upper respiratory tract function was performed using ultrasonography combined with color-flow and spectral Doppler analysis. In all cases with uncomplicated pregnancy, fetal breathing-related nasal and oropharyngeal fluid flow was seen at the level of the nose. The five cases with congenital diaphragmatic hernia all demonstrated fetal breathing activity by thoracic wall movement. In four of the fetuses, perinasal fluid flow was seen by the Doppler technique. The fetus with no demonstrated perinasal flow during breathing movements died in the early neonatal period and had pulmonary hypoplasia. Observation of the fetal breathing-related nasal and oropharyngeal fluid flow in cases of antenatally diagnosed congenital diaphragmatic hernia provides a rationale to hypothesize that the absence of this phenomenon is a useful marker for prenatal prediction of pulmonary hypoplasia
— id: 76543, year: 1993, vol: 3, page: 164, stat: Journal Article,

Detection of ovaries by transvaginal sonography in postmenopausal women
Gollub, E L; Westhoff, C; Timor-Tritsch, I E
1993 Nov 1;3(6):422-425, Ultrasound in obstetrics & gynecology
A total of 230 apparently healthy postmenopausal women underwent transvaginal sonography and pelvic examination. The mean ovarian volume was 3.1 cm(3) with a range of 0.4-57.4 cm(3) and fewer than 5% (4.8%) of the subjects had a mean volume exceeding two standard deviations of the sample mean. Transvaginal sonography successfully imaged 64% of reported ovaries overall, although the proportion of ovaries imaged varied by sonographer. The poorer imaging rates found in this study, as compared with some previous investigations using transabdominal sonography, could be due to several factors including the type of sonography, the type of sample, the scanning time, and/or the criteria used to identify an ovary. Transvaginal sonography offers practical advantages over transabdominal sonography, but the potential loss in sensitivity, due to non-visualization of a substantial proportion of ovaries, must be formally assessed before adopting transvaginal sonography more widely as the primary screening modality
— id: 76538, year: 1993, vol: 3, page: 422, stat: Journal Article,

First-trimester fetal biometry using transvaginal sonography
Lasser, D M; Peisner, D B; Vollebergh, J; Timor-Tritsch, I
1993 Mar 1;3(2):104-108, Ultrasound in obstetrics & gynecology
First-trimester fetal biometry using transvaginal sonography is now feasible and desirable due to improved imaging and probe maneuverability. A study of 144 early normal pregnancies with precise dates is presented. Regression models were constructed for the crown-rump length, biparietal diameter, head circumference and abdominal circumference. Error analysis of the technique and calculations was performed. First-trimester fetal biometry may be used for obtaining precise estimates of gestational age and may help to detect early fetal maldevelopment resulting in abnormal growth
— id: 76545, year: 1993, vol: 3, page: 104, stat: Journal Article,

Nomograms of the fetal lateral ventricles using transvaginal sonography
Monteagudo A; Timor-Tritsch IE; Moomjy M
1993 May;12(5):265-269, Journal of ultrasound in medicine
Nomograms of the fetal lateral ventricles were obtained by the transvaginal approach. Three hundred low-risk women with no sonographically apparent fetal anomalies were scanned prospectively in a cross-sectional study. Three measurements in the parasagittal plane, three in the midline coronal plane, and two in the posterior coronal plane were used to generate seven nomograms. Two additional nomograms reflecting two calculated ratios also were created. A mean regression line and the 5th and 95th confidence intervals were determined. We concluded that transvaginal sonography of the fetal brain generates images of both hemispheres of good enough resolution to allow several precise and reproducible measurements
— id: 25533, year: 1993, vol: 12, page: 265, stat: Journal Article,

Transvaginal multifetal pregnancy reduction: Which? When? How many?
Monteagudo, A; Timor-Tritsch, I E
1993 Jun;25(3):275-278, Annals of medicine (Helsinki)
This report contains the experience of our centre, using the transvaginally guided puncture procedure, to reduce the number of fetuses in a multifetal pregnancy to a lower number. The aim of the procedure was to improve perinatal outcome and/or to meet the personal desires of patients and their families. We surveyed 148 multifetal pregnancy reductions. The fetus or fetuses overlying the internal os was most commonly reduced. The total uncorrected loss of the entire pregnancy was 13.4%. The corrected pregnancy loss was 11%. Of the 63 twins left after the reduction, 33 delivered preterm. Of the 36 singletons, two delivered preterm. Our conclusion was that multifetal pregnancy reduction is a safe procedure for the mother and has an acceptable loss rate of the entire pregnancy. The reduction of a fetus overlying the internal os by the transvaginal puncture procedure seems to yield results at least as good as the transabdominally performed puncture procedures for multifetal pregnancy reduction
— id: 76542, year: 1993, vol: 25, page: 275, stat: Journal Article,

Cervical dilation: accuracy of visual and digital examinations
Timor-Tritsch, I
1993 Jun;81(6):1056-1057, Obstetrics & gynecology
— id: 76540, year: 1993, vol: 81, page: 1056, stat: Journal Article,

Diagnosis of placenta previa by transvaginal sonography
Timor-Tritsch, I E; Monteagudo, A
1993 Jun;25(3):279-283, Annals of medicine (Helsinki)
The evolution of the sonographic diagnosis of placenta previa is reviewed with special emphasis on transvaginal sonography (TVS), which has been proved accurate at diagnosing different degrees of placenta previa, such as complete, partial, marginal and low-lying. Bleeding tendency and the need for Caesarean delivery increases when the placental edge is within 3 cm of the internal os. There is no association between bleeding and use of transvaginal probes. The early diagnosis of addition abnormalities of implantation (e.g. placenta accreta) using transvaginal colour flow Doppler widens the prospects for carefully planned patient management. In conclusion, TVS should be the principal diagnostic modality used in the work-up of an obstetric patient with vaginal bleeding. The ease of performance and the clarity and accuracy of method and the additional information about implantation that it can provide will soon make TVS the 'golden standard' in the diagnostic process of placenta previa
— id: 76541, year: 1993, vol: 25, page: 279, stat: Journal Article,

The use of the transvaginal automated spring-loaded puncture device transabdominally
Timor-Tritsch, I E; Monteagudo, A
1993 Jan 1;3(1):42-44, Ultrasound in obstetrics & gynecology
Transabdominal use of a software integrated, automated, spring-loaded transvaginal puncture device is described. This device allows accurate, high-velocity needle placement into sonographically targeted areas under continuous direct vision without the use of local anesthesia. Successful use of the device in seven cases is described
— id: 76547, year: 1993, vol: 3, page: 42, stat: Journal Article,

Multifetal pregnancy reduction by transvaginal puncture: evaluation of the technique used in 134 cases
Timor-Tritsch, I E; Peisner, D B; Monteagudo, A; Lerner, J P; Sharma, S
1993 Mar;168(3 Pt 1):799-804, American journal of obstetrics & gynecology
OBJECTIVE: This report reviews multifetal pregnancy reductions performed transvaginally and tests the feasibility and associated pregnancy loss rates with this technique. STUDY DESIGN: One hundred thirty-four consecutive multifetal pregnancy reductions were analyzed regarding different aspects of total pregnancy losses and complications. The first 40 manually performed were compared with the last 94 procedures performed with an automated puncture device and a thin needle. The losses were also analyzed as a comparison of the reduction of the lower-lying with the higher-lying fetuses located in relation to the internal os. RESULTS: A total uncorrected total pregnancy loss rate of 12.6% and a corrected loss rate of 10.6% was observed. Of the 112 pregnancies in which the lower-lying fetus was reduced, 11 losses were seen. The loss rate in the group reducing the upper fetus was three of 22. The manual versus the puncture device groups showed the same loss rate (10%); however, the manual group had a larger number of subchorionic hematomas after the procedure. CONCLUSIONS: The data are indicative of a very low maternal complication rate (infection) and an acceptable loss rate of the entire pregnancy. The loss rates compare favorable with those for multifetal pregnancy reduction performed transabdominally
— id: 76546, year: 1993, vol: 168, page: 799, stat: Journal Article,

Confirming the safety of transvaginal sonography in patients suspected of placenta previa
Timor-Tritsch, I E; Yunis, R A
1993 May;81(5 ( Pt 1)):742-744, Obstetrics & gynecology
OBJECTIVE: To evaluate the safety of transvaginal ultrasonography in the diagnosis of placenta previa by determining whether the angle between the cervix and the vaginal probe is sufficient for alignment of the probe with the cervix. METHODS: The angle between the axis of the cervix and that of the vaginal probe (the axis of the vagina) was measured from copies of the transvaginal ultrasound examinations of 18 patients with documented placenta previa past 20 weeks' gestation. The measurements were compared with those of gestationally matched controls without placenta previa. RESULTS: The mean angles were 63.8 degrees and 67.5 degrees, with minimum angles of 44 degrees and 48 degrees for the placenta previa and control groups, respectively. The values were not statistically different. CONCLUSION: These findings strengthen the previously undocumented presumption that the angle between the cervix and vaginal probe is sufficient to prevent the probe from inadvertently slipping into the cervix. Therefore, this study supports the safety of transvaginal sonography in diagnosing and monitoring patients with known placenta previa
— id: 76544, year: 1993, vol: 81, page: 742, stat: Journal Article,

Placenta accreta: additional sonographic observations
Timor-Tritsch, I
1992 Jul;11(7):326-326, Journal of ultrasound in medicine
— id: 76551, year: 1992, vol: 11, page: 326, stat: Journal Article,

Standardization of ultrasonographic images: let's all talk the same language!
Timor-Tritsch, I E
1992 Sep 1;2(5):311-312, Ultrasound in obstetrics & gynecology
— id: 76550, year: 1992, vol: 2, page: 311, stat: Journal Article,

Transvaginal sonography in gynecologic office practice
Timor-Tritsch, I E
1992 Dec;4(6):914-920, Current opinion in obstetrics & gynecology
Recent technologic developments have made transvaginal ultrasound an important adjunct to gynecologic examination in both the office and the emergency room settings. Important advantages of using transvaginal ultrasonography to supplement bimanual examination are presented and discussed. Training and equipment issues, as well as medicolegal issues, are addressed
— id: 76549, year: 1992, vol: 4, page: 914, stat: Journal Article,

Sonographic evolution of cornual pregnancies treated without surgery
Timor-Tritsch, I E; Monteagudo, A; Matera, C; Veit, C R
1992 Jun;79(6):1044-1049, Obstetrics & gynecology
Transvaginal sonography allows early and accurate diagnosis of cornual pregnancy, as well as providing a means for puncture injection treatment of certain ectopic pregnancies. We describe four cases of cornual pregnancy managed nonsurgically and followed with transvaginal sonography for 47-64 weeks. Sonographic evidence of cornual pregnancy persisted throughout the period of follow-up, despite resumption of normal menstrual cyclicity. We conclude that some early live cornual pregnancies can be managed by puncture injection, and cornual pregnancies in which the embryo has died can be followed conservatively
— id: 76552, year: 1992, vol: 79, page: 1044, stat: Journal Article,

High-frequency transvaginal sonographic examination for the potential malformation assessment of the 9-week to 14-week fetus
Timor-Tritsch, I E; Monteagudo, A; Peisner, D B
1992 May;20(4):231-238, Journal of clinical ultrasound
A study was undertaken to evaluate the ability of the high-frequency transvaginal scanning method to consistently image first- and early second-trimester fetal structures, such as body contours, long bones, fingers, face, palate, feet, toes, and the four-chamber view. Ninety-seven low-risk pregnancies were scanned from 9 weeks to 14 menstrual weeks inclusive. Accurate dating was ascertained. The results showed that consistent detection of the respective structures was achieved at the following menstrual ages: sagittal contours at 9 weeks to 10 weeks, long bones at 10 weeks to 11 weeks, fingers at 12 weeks, face and palate at 12 weeks, feet and toes at 13 weeks, and the four-chamber view at 14 weeks. The organs and structures examined could be detected at 9 weeks to 14 weeks inclusive. An increasing number of structure were detected consistently with the increasing menstrual age. The study supports the possibility of searching for specific malformations at or after the menstrual ages mentioned, or performing a more comprehensive malformation evaluation after 13 weeks
— id: 76553, year: 1992, vol: 20, page: 231, stat: Journal Article,

Emergency room use of transvaginal ultrasonography by obstetrics and gynecology residents
Timor-Tritsch, I; Greenidge, S; Admon, D; Reuss, M L
1992 Mar;166(3):866-872, American journal of obstetrics & gynecology
OBJECTIVE: The objective of this study was to evaluate the feasibility and diagnostic value of the emergency room use of transvaginal ultrasonography operated by the obstetrics and gynecology residents. STUDY DESIGN: One hundred sixty-eight patients scanned in the emergency room constituted the study group and were compared with 61 patients for whom emergency room scanning was not available. Scanning and no-scanning days alternated for a 6-month period. The Student t test was used in the analysis. RESULTS: By comparing the two patient groups a statistically significant (p less than 0.0001) difference was seen in the time spent by the group of patients scanned in the emergency room (40 minutes) when compared with that of the patients for whom no emergency room scanning was available (215 minutes). The residents expressed high confidence in the scanning procedure. There were six misdiagnosed cases, three of them nonruptured ectopic gestations. However, none of these patients was discharged without adequate treatment. CONCLUSION: The study confirmed our hypothesis that obstetrics and gynecology residents can operate and should have available ultrasonography machines in the emergency departments to render quicker and better patient care
— id: 76554, year: 1992, vol: 166, page: 866, stat: Journal Article,

Fetal stomach measurements: not reproducible by the same observer
Zimmer, E Z; Chao, C R; Abramovich, G; Timor-Tritsch, I E
1992 Dec;11(12):663-665, Journal of ultrasound in medicine
We hypothesized that because fetal stomach filling and emptying is a dynamic process, measurements of the stomach dimensions might not be reproducible. Serial measurements 20 minutes apart were made of the stomach in 146 fetuses at 14 to 41 weeks of gestation. In 88 of these fetuses, the biparietal diameter also was measured to provide a standard for comparison. The mean percentage change between each of the paired measurements was 16.6% to 43.1% for the different stomach dimensions, compared with only 2% for the biparietal diameter (P < 0.001). We suggest that caution be excised in the diagnostic use of stomach measurements owing to their dynamically changing nature
— id: 76548, year: 1992, vol: 11, page: 663, stat: Journal Article,

Imaging the fetal brain in the second and third trimesters using transvaginal sonography
Monteagudo, A; Reuss, M L; Timor-Tritsch, I E
1991 Jan;77(1):27-32, Obstetrics & gynecology
High-frequency transvaginal probes were used at 20-40 weeks' gestation to develop a systematic examination of the fetal brain. Modeling the procedure after the standard neonatal neurosonographic examination, we attempted to obtain three coronal sections (anterior, midline, posterior) and two sagittal sections (midsagittal, right or left parasagittal). In 70 normal patients, all planes were imaged with a similar frequency (74-76%) except for the posterior coronal plane, which was imaged 59% of the time. Among the first 35 cases, 17% had a complete study, compared with 71% of the second 35 cases. Transvaginal sonography established or changed the diagnosis in five of the 13 cases with central nervous system or other abnormalities. We recommend that a complete fetal neurosonographic examination include transvaginal sonography to complement and enhance the transabdominal examination, especially for cases in which a fetal abnormality is suspected
— id: 76560, year: 1991, vol: 77, page: 27, stat: Journal Article,

Classification of tubal gestations by transvaginal sonography
Rottem, S; Thaler, I; Timor-Tritsch, I E
1991 May 1;1(3):197-201, Ultrasound in obstetrics & gynecology
Transvaginal sonographic images of tubal pregnancies were correlated with the surgical findings in 191 patients having this condition. The sonographic appearance of the ectopic gestations was classified by the absence or presence of structures such as a 'tubal ring' containing the yolk sac, embryonic structures, heart activity, a sonolucent or irregularly echogenic gestational sac, dilated Fallopian tube with amorphous content, fluid in the pelvis and an empty uterus. The following classifications were made: Type Ia (n = 43) A well-defined 'tubal ring' and a beating heart with or without discrete embryonic or extra-embryonic structures.Type Ib (n = 48) A 'tubal ring' containing embryonic and/or extra-embryonic structures without heart beats. Type II (n = 64) An ill-defined or thin tubal wall containing sonolucent or an irregularly echogenic core but not embryonic or extra-embryonic structures. Type III (n = 28) Free pelvic fluid and an empty uterus in patients with positive serum beta-hCG levels. The outline of the tube cannot be visualized. Surgery revealed unruptured tubal pregnancies in 90 patients of the combined groups of Types Ia and Ib. In one additional patient, a tubal rupture was found. In the Type II patients, 26 tubal pregnancies with blood clots in the tube but no evidence of bleeding into the pelvis, and 38 tubal ruptures or abortions were diagnosed. All Type III patients had ruptured tubal pregnancies or bleeding tubal abortions. In eight patients (4.2%), the only sonographic finding was an empty uterus, and these cases were erroneously diagnosed as not having an ectopic pregnancy (false negatives). There were two false-positive cases in which a tubal ring was detected, and this was related to an hemorrhagic corpus luteum. When used for diagnosing tubal pregnancy, the transvaginal scanning technique (together with beta-hCG in Type III cases) carries a sensitivity of 95.8% and specificity of 99.9%. It is an invaluable tool in the diagnostic work-up and management of patients with suspected ectopic gestation
— id: 76557, year: 1991, vol: 1, page: 197, stat: Journal Article,

Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy
Sassone, A M; Timor-Tritsch, I E; Artner, A; Westhoff, C; Warren, W B
1991 Jul;78(1):70-76, Obstetrics & gynecology
With the advent of high-frequency transvaginal ultrasonography, new opportunities are presented to better define ovarian lesions. The goal of this study was to develop a scoring system using transvaginal sonographic characterization of pelvic/ovarian lesions. Our purpose was to maximize the discrimination between benign and malignant entities. Transvaginal sonographic pelvic images of 143 patients were correlated with surgical findings or histopathology. Of 281 ovaries, 108 had benign lesions (30 endometriomas, 24 teratomas, 21 simple cysts, and 33 other abnormalities) and 20 had malignancies. The scoring system devised was useful in distinguishing benign from malignant masses, with a specificity of 83%, sensitivity of 100%, and positive and negative predictive values of 37 and 100%, respectively. Further experience and refinements of this method of scoring should maximize the benefit of high-resolution transvaginal sonography of ovarian lesions
— id: 76556, year: 1991, vol: 78, page: 70, stat: Journal Article,

Transvaginal sonographic evaluation of the fetal central nervous system
Timor-Tritsch, I E; Monteagudo, A
1991 Dec;18(4):713-748, Obstetrics & gynecology clinics of North America
This article describes the sonographic appearance of the central nervous system (CNS) from about 6 weeks to term. Highlights of CNS development and the chronologic appearance of sonographically detected new structures throughout gestation are presented
— id: 76555, year: 1991, vol: 18, page: 713, stat: Journal Article,

Transvaginal ultrasonographic definition of the central nervous system in the first and early second trimesters
Timor-Tritsch, I E; Monteagudo, A; Warren, W B
1991 Feb;164(2):497-503, American journal of obstetrics & gynecology
A 6.5 MHz transvaginal sector scanner was used to describe the fetal central nervous system anatomy from 6 to 14 weeks. One hundred thirty-three pregnant patients were scanned after the crown-rump measurements were found to be within a range of less than or equal to 4 days from menstrual age. The number of possible ultrasonographic sections ('slices'), as well as the number of successful views in the axial, coronal, and sagittal sections, was tabulated. A detailed list of central nervous system structures that are seen at each gestational age is presented. The results showed that a significant number of brain structures could be imaged. The number and the clarity of the structures and the number of successful views in the three scanning planes increased with gestational age. We concluded that transvaginal scanning for central nervous system maldevelopment can be started in the late first and early second trimesters
— id: 76559, year: 1991, vol: 164, page: 497, stat: Journal Article,

Puncture procedures utilizing transvaginal ultrasonic guidance
Timor-Tritsch, I E; Peisner, D B; Monteagudo, A
1991 Mar 1;1(2):144-150, Ultrasound in obstetrics & gynecology
The introduction of transvaginal sonography has enabled the use of this scanning method for guided puncture procedures. A total of 102 puncture procedures are described: 63 fetal reductions, eight punctures of ectopic pregnancies, 19 drainages of pelvic contents, seven punctures of ovarian cysts, four diagnostic culdocenteses and one injection of a cervical pregnancy.Every procedure is discussed in detail. There was only one procedure-related complication. The advantages of the ultrasound-guided vaginal puncture procedure are its performance under real-time imaging, a low complication rate, a better pregnancy outcome when considering the reduction of multifetal gestations, and, most importantly, the fact that abdominal surgery can be avoided in several cases
— id: 76558, year: 1991, vol: 1, page: 144, stat: Journal Article,

Early detection of caudal regression syndrome with transvaginal scanning
Baxi, L; Warren, W; Collins, M H; Timor-Tritsch, I E
1990 Mar;75(3 Pt 2):486-489, Obstetrics & gynecology
High-resolution transvaginal ultrasonography may recognize structures in the first- and early second-trimester fetus. In a patient with pregestational diabetes, caudal regression syndrome in the fetus was diagnosed using transvaginal ultrasonography. At 9 weeks of gestation, a shortening of the crown-rump length and a protuberance of the lower spine suggested caudal regression syndrome. By 17 weeks of gestation, the diagnosis was made with certainty. The transvaginal approach has changed the role of first-trimester ultrasound in the diabetic pregnancy. We suggest that transvaginal ultrasonography be used for purposes of accurate dating and for early detection of diabetic embryopathy, particularly in patients with poor periconceptional glycemic control
— id: 76568, year: 1990, vol: 75, page: 486, stat: Journal Article,

Placenta previa--is the traditional diagnostic approach satisfactory?
Farine, D; Peisner, D B; Timor-Tritsch, I E
1990 May;18(4):328-330, Journal of clinical ultrasound
The accuracy of the diagnosis of placenta previa using transvaginal sonography (TVS) was compared to that of the traditional transabdominal sonography (TAS). Seventy seven women were scanned by both methods and each sonographic diagnosis was compared to the placental location at delivery. TVS was superior to TAS in diagnosing placenta previa and invariably correct in ruling it out. TVS (and TAS) failed to predict the placental location at delivery only in women diagnosed as having marginal placenta previa prior to 35 weeks gestation. The use of the vaginal probe significantly improved the accuracy of the diagnosis of placenta previa
— id: 76563, year: 1990, vol: 18, page: 328, stat: Journal Article,

Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas
Guy, G P; Peisner, D B; Timor-Tritsch, I E
1990 Sep;163(3):723-727, American journal of obstetrics & gynecology
Transvaginal ultrasonography was used to evaluate antepartum bleeding in a group of 76 patients at varying gestational ages with suspected placenta previa. The clinical outcome of 16 patients with persistent placenta previa was documented. Nine of the 16 patients had placental lacunar blood flow. Two of the nine patients were lost to follow-up. At cesarean section the seven patients with lacunar flow had a higher incidence of blood loss, transfusion requirements, abnormally implanted placenta, and cesarean hysterectomy than the six patients in whom no lacunar flow patterns were seen (p = 0.002). The finding of these flow patterns with abnormally located placentas suggests the anticipation of significant blood loss and probable extension of operative procedures to stop the blood loss
— id: 76561, year: 1990, vol: 163, page: 723, stat: Journal Article,

The discriminatory zone of beta-hCG for vaginal probes
Peisner, D B; Timor-Tritsch, I E
1990 May;18(4):280-285, Journal of clinical ultrasound
Recent developments in both laboratory measurements and ultrasound technology have revolutionized the management of early pregnancy. The discriminatory zone concept is a direct result of these developments. By correlating the serum beta-hCG values to the size of an intrauterine gestational sac, a value can be chosen that corresponds to the threshold of visualization of the sac. If the beta-hCG is above this value, a sac must be seen, and if it is not, aggressive steps should be taken to determine whether the pregnancy is abnormal or ectopic. The discriminatory zone may vary among institutions due to different equipment and assays. Thus, its value should be calculated individually at each institution. A proper discriminatory zone and a management protocol such as the one above can eliminate much of the uncertainty in the management of suspected ectopic and early pregnancies
— id: 76566, year: 1990, vol: 18, page: 280, stat: Journal Article,

Transvaginal sonographic technique: targeted organ scanning without resorting to "planes"
Rottem, S; Thaler, I; Goldstein, S R; Timor-Tritsch, I E; Brandes, J M
1990 May;18(4):243-247, Journal of clinical ultrasound
The orientation of the sonographer performing a transvaginal scan is currently based on a concept of anatomical planes, which is customary in transabdominal sonography. We challenge this concept and propose a different approach altogether based on focusing on target organs rather than anatomic planes. The problem of orientation in transvaginal sonography stems from the following: (1) There is a very short distance between the relatively high-frequency transvaginal transducer-probe and the scanned area; a close-up image is generated encompassing a single organ or only part of it. (2) The scanning angle is initially perpendicular to that of abdominal sonography. (3) Transvaginal sonography is an endocavitary dynamic scanning technique. According to the experience in our department (30,000 examinations during the past 4 years) and in two other medical centers, best results from the transvaginal ultrasonographic examination are achieved when the operator searches for every specific organ as the main target, without resorting to pelvic 'planes.' The guidelines for targeted organ scanning and the associated change in orientation are reported together with the limitations. Targeted organ scanning without resorting to 'planes' helps the operator to resolve the problem of orientation during the transvaginal ultrasonographic examination, and to simplify the procedure to a great extent
— id: 76565, year: 1990, vol: 18, page: 243, stat: Journal Article,

Changes in uterine blood flow during human pregnancy
Thaler, I; Manor, D; Itskovitz, J; Rottem, S; Levit, N; Timor-Tritsch, I; Brandes, J M
1990 Jan;162(1):121-125, American journal of obstetrics & gynecology
A transvaginal duplex Doppler ultrasonography system was used to measure blood flow characteristics in the ascending uterine artery before and during pregnancy. The system uses a 5 MHz Doppler transducer coupled to a 6.5 MHz imaging probe. There was a steady increase in volume flow rate in the left ascending uterine artery from a mean of 94.5 ml/min before pregnancy to a mean of 342 ml/min in late gestation (reflecting a 3.5-fold increase). With the assumption of equal flow on both uterine arteries, the fraction of the cardiac output that is distributed to these vessels was calculated to be 3.5% in early pregnancy and to reach 12% near term. The mean diameter of this vessel in the nonpregnant state was 1.6 mm, increasing to 3.7 mm toward term. The resistance to flow, expressed as the peak systolic to end-diastolic flow velocity ratio, declined from a mean of 5.3 in the nonpregnant state to a mean of 2.3 near term. These changes reflect the perpetual growth and development of the uteroplacental circulation, which provides the metabolic demands of the growing fetus throughout gestation
— id: 76569, year: 1990, vol: 162, page: 121, stat: Journal Article,

Hemodynamic evaluation of the female pelvic vessels using a high-frequency transvaginal image-directed Doppler system
Thaler, I; Manor, D; Rottem, S; Timor-Tritsch, I E; Brandes, J M; Itskovitz, J
1990 May;18(4):364-369, Journal of clinical ultrasound
Perfusion characteristics of the female pelvic vessels were studied by a high-frequency transvaginal image-directed Doppler system. A 5-MHz Doppler transducer was coupled to a 6.5-MHz probe especially designed for intravaginal use. Distinct patterns of flow velocity waveforms were obtained from the ascending branch of the uterine artery, before and during pregnancy. A gradual increase in diastolic flow throughout gestation was observed, consistent with a decrease in vessel resistance. Flow velocity profiles in the ovarian artery were sampled from the infundibulo-pelvic ligament. Only limited diastolic flow could be detected in either ovary during the follicular phase of the cycle. In the luteal phase there was a marked increase in this flow but only in the ovary containing the corpus luteum. In early pregnancy the high diastolic flow was maintained or even increased, consistent with a low arterial resistance. High image resolution and a higher frequency Doppler transducer increase the usefulness of this technique in the hemodynamic evaluation of the female pelvic vessels
— id: 76562, year: 1990, vol: 18, page: 364, stat: Journal Article,

Is office use of vaginal ultrasonography feasible?
Timor-Tritsch, I E
1990 Apr;162(4):983-985, American journal of obstetrics & gynecology
Technical advances involving ultrasonographic equipment in the last years enabled the wide use of the high-resolution, 5.0 to 7.5 MHz transducers as endovaginal probes. The clear images produced are easy to interpret and, if obtained at the same time, can be used effectively to complement a routine bimanual pelvic examination. Formal teaching of the technique is imperative. This should be done by means of incorporating ultrasonography, in general, and transvaginal sonography, in particular, in formal residency training. The reasons for incorporating transvaginal sonographic examination in the standard pelvic examination done in the office or the emergency room are discussed
— id: 76567, year: 1990, vol: 162, page: 983, stat: Journal Article,

Sonoembryology: an organ-oriented approach using a high-frequency vaginal probe
Timor-Tritsch, I E; Peisner, D B; Raju, S
1990 May;18(4):286-298, Journal of clinical ultrasound
First trimester gestations of 95 patients were studied by high-frequency transvaginal sonography, which permits the imaging of organs shortly after their development. This new technique has great potential for clinical implementation in such cases as accurate gestational dating and malformation workup
— id: 76564, year: 1990, vol: 18, page: 286, stat: Journal Article,

Is it really a placenta previa?
Farine, D; Fox, H E; Jakobson, S; Timor-Tritsch, I E
1989 May;31(2):103-108, European journal of obstetrics, gynecology & reproductive biology
Transvaginal sonography was compared to the traditional transabdominal sonography for diagnosing placenta previa. There was no vaginal bleeding in the 55 women studied following vaginal examination. The exact location of the internal os was diagnosed in all women by the vaginal route, and only in 36 of the 55 by abdominal scanning. Transvaginal sonography correctly diagnosed 39 out of the delivered 45 women, whereas transabdominal sonography only did so in 20 of the 45 cases. These results suggest that transvaginal sonography for the diagnosis of placenta previa is safe and superior to transabdominal sonography
— id: 76574, year: 1989, vol: 31, page: 103, stat: Journal Article,

Vaginal ultrasound for ruling out placenta praevia. Case report
Farine, D; Fox, H E; Timor-Tritsch, I
1989 Jan;96(1):117-119, British journal of obstetrics & gynaecology
— id: 76576, year: 1989, vol: 96, page: 117, stat: Journal Article,

[Vaginal ultrasonography: a new testing method in obstetrics and gynecology]
Timor-Tritsch, I E; Bartfai, G; Kaali, S G
1989 Jun 4;130(23):1203-1207, Orvosi hetilap
Transvaginal sonography represents a new tool for the gynecological diagnosis and decision making. The authors present theoretical and practical aspects of transvaginal sonography with special emphasis on the 6.5 MHz vaginal probe. Based on one thousand one hundred and eight examinations it is obvious that this procedure is valuable in diagnostic algorithm of ectopic pregnancy and to follow follicular growth, as well as ultrasound guided oocyte retrieval
— id: 76573, year: 1989, vol: 130, page: 1203, stat: Journal Article,

First-trimester midgut herniation: a high-frequency transvaginal sonographic study
Timor-Tritsch, I E; Warren, W B; Peisner, D B; Pirrone, E
1989 Sep;161(3):831-833, American journal of obstetrics & gynecology
The application of high-frequency transvaginal sonography offers new opportunities in scanning for malformations during the first trimester of pregnancy. Scanning of the anterior abdominal wall and the umbilical cord insertion at this gestational age is feasible. A cross-sectional study of 61 embryos-fetuses from 7 to 12 weeks of gestation was performed to observe the physiologic midgut hernia. This herniation was detected in 64% of the cases at 8 weeks, in 100% during weeks 9 and 10, and in 25% at 11 weeks' gestation. None of the fetuses studied at 12 weeks had a midgut herniation. Vaginal sonography of the well-dated fetus at 12 weeks can confirm the final development of the anterior abdominal wall
— id: 76571, year: 1989, vol: 161, page: 831, stat: Journal Article,

The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy
Timor-Tritsch, I E; Yeh, M N; Peisner, D B; Lesser, K B; Slavik, T A
1989 Jul;161(1):157-161, American journal of obstetrics & gynecology
Despite advances in diagnosis made by the introduction of serum beta-subunit of human chorionic gonadotropin determinations and transabdominal ultrasonography, ectopic gestations still present a major diagnostic challenge. The increased resolution of the transvaginally introduced high-frequency ultrasound transducer probes seems to solve this diagnostic problem. In this study 145 patients were referred for ultrasonographic workup because of a suspected ectopic gestation. In 38 patients a diagnosis could be made with classical transabdominal scanning. One hundred seventeen patients required additional transvaginal scanning with a 5.0 and a 6.5 MHz probe. In 98 patients a diagnosis was made during the first transvaginal scan; nine patients were rescanned within 3 days for the final diagnosis. In 56 patients, ectopic pregnancy was successfully ruled out by transvaginal scanning. Thirty-nine ectopic pregnancies were diagnosed. Only one false-positive identification was made. The sensitivity of diagnosing ectopic pregnancy by high-frequency transvaginal sonography was 100%; the specificity was 98.2%. The positive predictive value of this method was 98%, and the negative predictive value was 100%. The rate of the beating fetal heart was seen in the tube (23%). The high number of unruptured tubal pregnancies in this series (66%) suggests the possibility of an early diagnosis that may have therapeutic implications. The use of higher-frequency transvaginal transducer probes improves the diagnosis of the ectopic gestation
— id: 76572, year: 1989, vol: 161, page: 157, stat: Journal Article,

Transvaginal salpingocentesis: a new technique for treating ectopic pregnancy
Timor-Tritsch, I; Baxi, L; Peisner, D B
1989 Feb;160(2):459-461, American journal of obstetrics & gynecology
Transvaginal sonography is an important tool for diagnosing ectopic pregnancy. In this report the transvaginal passage of a needle, with sonographic guidance, into a tubal gestational sac with a live fetus is demonstrated. We injected potassium chloride solution to arrest cardiac activity, terminating the ectopic pregnancy without surgical intervention. The new therapeutic use of transvaginal sonography is an important addition to the treatment of this prevalent disease
— id: 76575, year: 1989, vol: 160, page: 459, stat: Journal Article,

Dating the early pregnancy by sequential appearance of embryonic structures
Warren, W B; Timor-Tritsch, I; Peisner, D B; Raju, S; Rosen, M G
1989 Sep;161(3):747-753, American journal of obstetrics & gynecology
A total of 97 transvaginal scans were performed from 4 to 12 weeks' gestation in normal and accurately dated gestations. The sequential appearance of six structures were examined: (1) the gestational sac only was present during week 4; (2) the yolk sac appeared in week 5; (3) the fetal pole with detectable heart motion was first seen in week 6; (4) the single unpartitioned ventricle in the brain marked week 7; (5) the falx cerebri appeared during week 9; and (6) the appearance and the disappearance of the physiologic midgut herniation were seen in week 8 and week 11, respectively. Inasmuch as the time in gestation at which these structures appear characterizes the gestational age more than any measurement at this age, we propose a practical method to determine the correct gestational age in early first-trimester pregnancy
— id: 76570, year: 1989, vol: 161, page: 747, stat: Journal Article,

Vaginal ultrasound for diagnosis of placenta previa
Farine, D; Fox, H E; Jakobson, S; Timor-Tritsch, I E
1988 Sep;159(3):566-569, American journal of obstetrics & gynecology
Transvaginal sonography was compared with transabdominal sonography in 35 women with suspected placenta previa. The transvaginal sonographic technique did not result in vaginal bleeding in any of the patients. The internal os and its relationship to the location of the placenta were visualized by transvaginal sonography in all patients, but only in 24 patients (69%) by transabdominal sonography. Transvaginal sonography ruled out placenta previa in 13 cases thought to be placenta previa by abdominal sonography. The transvaginal diagnosis in these 13 patients was confirmed at delivery. Thirty-four of the 35 women have been delivered. The diagnosis at delivery confirmed the transvaginal sonographic diagnosis in 29/34 cases and the transabdominal diagnosis in 16/34. Transvaginal sonography did not predict the delivery diagnosis in five patients who were erroneously believed to have placenta previa by both sonographic techniques
— id: 76578, year: 1988, vol: 159, page: 566, stat: Journal Article,

Transvaginal sonography provides a sharper view into the pelvis
Modica, M M; Timor-Tritsch, I E
1988 Mar-Apr;17(2):89-95, Journal of obstetric, gynecologic, & neonatal nursing
Transvaginal sonography with a high-frequency probe, a recent development gaining clinical application, obtains better image resolution of deep pelvic organs. Uses of transvaginal sonography include diagnosis and treatment in gynecology, infertility, and early pregnancy. Acceptance by health-care providers and patients is widespread. Advantages include greater clinical capability, increased efficiency, and reduced costs. The nurse's role in patient education and management is a vital component of the care of the patient undergoing transvaginal sonography
— id: 76580, year: 1988, vol: 17, page: 89, stat: Journal Article,

Hickman catheter used in a pregnant patient for prolonged plasmapheresis treatment
Shechter, Y; Levene, C; Thaler, I; Timor-Tritsch, I E
1988 ;67(1):89-90, Acta obstetricia & gynecologica Scandinavica
— id: 76581, year: 1988, vol: 67, page: 89, stat: Journal Article,

Interpretation of the fetal ECG during labor: the effect of uterine contractions
Thaler I; Timor IE; Goldberg I
1988 ;16(4):373-379, Journal of perinatal medicine
This study was performed in order to investigate the fetal electrocardiogram (FECG) during uterine contractions associated with normal labor. Twenty-five patients with low risk pregnancy between 38-41 weeks gestation were studied during the active stage of labor. Both FECG and intra-uterine pressure are obtained in a conventional manner and are continually sampled into the computer. The FECG is averaged point-to-point, synchronized to the peak of the R-wave. This is performed by a QRS detection algorithm which is based on a digital analysis of slope, amplitude and width. A digital band-pass filter composed of cascaded high-pass and low-pass filters reduces false detections and permits the use of auto-adjustable low thresholds. A separate averaging is performed on the T-wave in order to prevent attenuation due to variable R-T interval. The T wave is subsequently aligned in time and position to the rest of the QRS complex. A significant increase was observed in the T/QRS amplitude ratio during the first half of the uterine contraction. Such an increase was also observed in the short and long-term FHR variability. No significant changes were observed in the other components of the FECG. In conclusion, by implementing a computer based system it is possible to analyse the FECG during labor. Based on this and previous studies it may well prove to be a sensitive indicator of fetal condition
— id: 32313, year: 1988, vol: 16, page: 373, stat: Journal Article,

The technique of transvaginal sonography with the use of a 6.5 MHz probe
Timor-Tritsch, I E; Bar-Yam, Y; Elgali, S; Rottem, S
1988 May;158(5):1019-1024, American journal of obstetrics & gynecology
Ultrasonography has become an important tool in infertility and obstetric practice. Its use in gynecology, while effective, has been less. This article describes the use of a high-frequency 6.5 MHz probe specially designed for intravaginal use. The technique is presented, along with a description of its uses and findings by organ. Patient acceptance has been universal. Its high resolution makes this technique more useful in general gynecologic practice
— id: 76579, year: 1988, vol: 158, page: 1019, stat: Journal Article,

A close look at early embryonic development with the high-frequency transvaginal transducer
Timor-Tritsch, I E; Farine, D; Rosen, M G
1988 Sep;159(3):676-681, American journal of obstetrics & gynecology
Transabdominal sonography has been, for the past two decades, used as an effective diagnostic and research tool in obstetrics. It is predominantly used in the second and third trimesters of gestation. Its use in the first trimester is relatively limited and mostly diagnostic in nature. The introduction of the higher frequency transvaginal transducer probe, with its higher resolution of the images, opens new possibilities to study early gestation. We studied embryonic development in 38 well-dated and normal pregnancies. A well-defined intrauterine gestational sac could be seen at 4 weeks and 1 to 4 days of menstrual age. The beta-subunit of human chorionic gonadotropin level at this time was 450 to 750 mlU/ml. Structures such as the yolk sac, membranes, ventricular system in the brain, musculoskeletal system, and cord were described and illustrated. Textbooks and atlases were used for comparative purposes. High-resolution transvaginal sonography will facilitate first-trimester perinatology
— id: 76577, year: 1988, vol: 159, page: 676, stat: Journal Article,

Reduction of the number of embryos in a multiple pregnancy: quintuplet to triplet
Brandes, J M; Itskovitz, J; Timor-Tritsch, I E; Drugan, A; Frydman, R
1987 Aug;48(2):326-327, Fertility & sterility
The technique for reduction of the number of embryos was applied in a patient who conceived following IVF and transfer of six embryos. On the 10th week of gestation, the number of embryos was reduced from five to three by an U/S-guided intra-uterine procedure. Two healthy girls and a boy were delivered in the 36th week by cesarean section. No trace of the other two fetuses was found. The moral and technical aspects of partial preventive termination of multiple pregnancy are discussed
— id: 76584, year: 1987, vol: 48, page: 326, stat: Journal Article,

Early treatment by plasmapheresis in a woman with multiple abortions and the rare blood group p
Shechter, Y; Timor-Tritsch, I E; Lewit, N; Sela, R; Levene, C
1987 ;53(3):135-138, Vox sanguinis
Women with the rare blood group p are known to have an increased rate of abortions. The case of a 36-year-old woman is presented who had had 7 spontaneous abortions in the first trimester and no live child. When treated by plasma exchange begun early in pregnancy and continued until the 29th week, she delivered a normal child. Time to begin, amount and length of time necessary to continue plasma exchange in these patients are considered. In addition, the question of which fraction of the anti-PP1Pk could be responsible for abortion is discussed. To our knowledge, this is the first case of a woman of p phenotype with no live children but with multiple abortions treated by this method, which should be seriously considered in similar cases
— id: 76586, year: 1987, vol: 53, page: 135, stat: Journal Article,

Study of fetal physiologic parameters in the light of fetal sleep states
Timor-Tritsch, I E
1987 Jun;156(6):1553-1553, American journal of obstetrics & gynecology
— id: 76585, year: 1987, vol: 156, page: 1553, stat: Journal Article,

Transvaginal ultrasonographic study of the fallopian tube
Timor-Tritsch, I E; Rottem, S
1987 Sep;70(3 Pt 1):424-428, Obstetrics & gynecology
The use of transabdominal/transvesical sonography in gynecologic diagnosis is limited by the physical properties of the transducers used as well as the lack of sufficient acoustic interfaces. Therefore, delicate tubal structures cannot be visualized adequately. Transvaginal application of a 6.5-MHz transducer probe (with a 10-mm crystal) enables the effective use of higher frequencies, enhancing resolution. This higher resolution improves picture quality and increases potential diagnostic power in evaluating the female pelvis in general and the fallopian tube in particular. This report presents the sonographic picture of the normal and pathologic tube. Tubal pathology should be described in terms of the tubal cavity, walls, and content, as well as location and mobility. The more frequently encountered clinical entities, such as the fluid-filled tube, tubo-ovarian inflammatory processes, and tubal gestation are discussed
— id: 76583, year: 1987, vol: 70, page: 424, stat: Journal Article,

In vitro training model for diagnostic and therapeutic fetal intravascular needle puncture
Timor-Tritsch, I E; Yeh, M N
1987 Oct;157(4 Pt 1):858-859, American journal of obstetrics & gynecology
An in vitro model, simple to assemble, consisting of a fresh placenta suspended in a water bath, is presented for the training of physicians interested in practicing ultrasound-guided fetal intravascular needle placement
— id: 76582, year: 1987, vol: 157, page: 858, stat: Journal Article,

Postmenopausal tubo-ovarian abscess
Fisher, M; Drugan, A; Govrin, J; Timor-Tritsch, I E; Brandes, J M
1986 ;65(6):661-663, Acta obstetricia & gynecologica Scandinavica
Tubo-ovarian abscess in postmenopausal women is a distinct and rare entity. The disease is usually diagnosed on the operating table and its high rate of postoperative complications and mortality commands special attention. By presenting our experience with four cases of tubo-ovarian abscess in postmenopausal women, we would like to re-emphasize the importance of including this disease in the differential diagnosis of the surgeon and the gynecologist. Early laparotomy is essential to reduce morbidity and mortality
— id: 76588, year: 1986, vol: 65, page: 661, stat: Journal Article,

The effect of external stimuli on fetal behaviour
Timor-Tritsch, I E
1986 May;21(5-6):321-329, European journal of obstetrics, gynecology & reproductive biology
The sensory receptors of the human fetus and their adequate stimulation are reviewed. Emphasis is put on the two main sensory routes through which the fetus may be stimulated: the hearing and the cutaneous senses. Most experimental and descriptive studies were done in these two well-defined areas. The core of the review deals with the description of sensory stimulation of the fetus as a function of the known behavioral states. It is postulated, and a series of experimental works cited in support, that reactions of the fetus to external stimuli, irrespective of the route through which they are presented, are subject to modulation by these states. It is proposed that an adequate stimulus in the normal, physiological range produces little or almost no effect in deep sleep (state 1 fetal) and does not change this state, whereas an inadequate stimulus which is strong ('painful') produces a definite change in state 1 fetal and is capable of triggering a change from state 1F to 2F (active sleep or rapid-eye-movement sleep)
— id: 76587, year: 1986, vol: 21, page: 321, stat: Journal Article,

Multichannel automatic foetal movement monitoring and classification system
Florentin, I; Inbar, G F; Timor-Tritsch, I E
1985 Mar;23(2):178-186, Medical & biological engineering & computing
— id: 76589, year: 1985, vol: 23, page: 178, stat: Journal Article,

Effect of acute hypoxia on human fetal heart rate. The significance of increased heart rate variability
Thaler, I; Timor-Tritsch, I E; Blumenfeld, Z
1985 ;64(1):47-50, Acta obstetricia & gynecologica Scandinavica
The fetal heart rate response to acute hypoxemia was observed during an accidental drop in oxygen concentration inspired by the mother in labor. There was a marked increase in FHR variability in the early stage of hypoxia and also during the recovery phase. While an increase in fetal heart variability is generally considered to be a normal physiological event, it may also indicate a state of fetal hypoxemia associated with an intact fetal circulation, and should be treated with caution during labor
— id: 76590, year: 1985, vol: 64, page: 47, stat: Journal Article,

An epidemic-like appearance of congenital cystic hygroma
Zimmer, E Z; Divon, M Y; Raijman, A; Timor-Tritsch, I E; Paldi, E; Peretz, B A
1984 ;63(5):451-453, Acta obstetricia & gynecologica Scandinavica
Five fetuses with cystic hyroma were diagnosed in our department during a period of 5 months. Four of them were identified by an ultrasonic examination. No common causative factor was found to explain the appearance of such a rare anomaly in 5 cases over a very short period of time
— id: 76591, year: 1984, vol: 63, page: 451, stat: Journal Article,

Sinusoidal pattern together with signs of moderate fetal hypoxia associated with a true knot of cord
Goldstein, I; Timor-Tritsch, I E; Zaidise, I; Divon, M; Paldi, E
1981 Feb;11(4):221-225, European journal of obstetrics, gynecology & reproductive biology
The fetal heart rate pattern of a dying fetus due to tightening of a true knot of cord is presented. Sinusoidal pattern was electronically recorded along wih bradycardia--tachycardia. The importance of the sinusoidal pattern is discussed. It seems to imply fetal compromise if observed together with other signs of moderate fetal distress
— id: 76593, year: 1981, vol: 11, page: 221, stat: Journal Article,

Estimation of fetal weight by real-time sonography
Timor-Tritsch, I E; Itskovitz, J; Brandes, J M
1981 May;57(5):653-656, Obstetrics & gynecology
The accuracy of estimating fetal weight with real-time ultrasonography was studied in 81 fetuses. The technique is described and results are compared with those obtained by the B-scan technique. The absolute mean error was 228 g or 8.3% of the mean weight. Sixty percent of the measurements fell within 10% of the actual birth weight. The estimates were more accurate in the low (less than 1500 g) and in the high (more than 4000 g) weight groups. The easy access, simple technique, and reasonable accuracy of realtime scanners, as well as the development in progress for more reliable instruments, enable us to advocate its value for estimation of fetal weight in the delivery suite
— id: 76592, year: 1981, vol: 57, page: 653, stat: Journal Article,

[Pregnancy with extrahepatic portal hypertension]
Blumenfeld, Z; Brandes, J M; Timor-Tritsch, I E
1980 Feb 1;98(3):116-117, Harefuah: journal of the Israeli Medical Association
— id: 76595, year: 1980, vol: 98, page: 116, stat: Journal Article,

Regular and irregular human fetal respiratory movement
Timor-Tritsch, I E; Dierker, L J Jr; Hertz, R H; Chik, L; Rosen, M G
1980 Sep;4(3):315-324, Early human development
Fetal respiratory movements (FRM) were studied using abdominal strain gauges (tocodynamometers). The patterns of the FRM were evaluated during both active and quiet fetal time periods, which were determined by the fetal heart rate (FHR) and fetal body movement (FM). The FRM were classified into Regular and Irregular patterns based on neonatal respiratory criteria for sleep-state studies in the term infant. Evaluation of the breath-to-breath intervals (BBI) showed statistically significant respiratory differences during active and quiet fetal time periods. Irregular fetal respiratory movement patterns were noted during fetal active periods. It would appear that the correlation of regular fetal respiratory movement with fetal quiet periods in the term fetus adds additional evidence that a quiet sleep state may exist in the term fetus
— id: 76594, year: 1980, vol: 4, page: 315, stat: Journal Article,

Fetal respiration: a review of two techniques for observation
Dierker, J F Jr; Hertz, R H; Timor-Tritsch, I; Rosen, M G
1979 Sep;22(3):593-604, Clinical obstetrics & gynecology
— id: 76600, year: 1979, vol: 22, page: 593, stat: Journal Article,

Continuous ultrasound and fetal movement
Hertz, R H; Timor-Tritsch, I; Dierker, L J Jr; Chik, L; Rosen, M G
1979 Sep 1;135(1):152-154, American journal of obstetrics & gynecology
— id: 76598, year: 1979, vol: 135, page: 152, stat: Journal Article,

Intrauterine fetal arrhythmia: atrial premature beats
Itskovitz, J; Timor-Tritsch, I; Brandes, J M
1979 Mar-Apr;16(5):419-421, International journal of gynaecology & obstetrics
A case of antepartum fetal arrhythmia is reported. The diagnosis of atrial premature beats was confirmed during labor by simultaneous recording of fetal heart rate and fetal electrocardiogram. The possibility of fetal distress during labor was excluded by fetal heart rate and acid-base monitoring. The difficulty of reaching a definitive antepartum diagnosis of the arrhythmia and its significance in relation to fetal well-being are discussed
— id: 76602, year: 1979, vol: 16, page: 419, stat: Journal Article,

Fetal behavioral states and fetal evaluation
Rosen, M G; Dierker, L J Jr; Hertz, R H; Sorokin, Y; Timor-Tritsch, I
1979 Sep;22(3):605-616, Clinical obstetrics & gynecology
— id: 76596, year: 1979, vol: 22, page: 605, stat: Journal Article,

Monitoring fetal movement
Rosen, M G; Hertz, R H; Dierker, L J Jr; Zador, I; Timor-Tritsch, I E
1979 Aug;6(2):325-334, Clinics in obstetrics & gynecology
— id: 76601, year: 1979, vol: 6, page: 325, stat: Journal Article,

Fetal movement: a brief review
Timor-Tritsch, I E; Dierker, L J Jr; Hertz, R H; Rosen, M G
1979 Sep;22(3):583-592, Clinical obstetrics & gynecology
— id: 76597, year: 1979, vol: 22, page: 583, stat: Journal Article,

Human fetal respiratory movements: a technique for noninvasive monitoring with the use of a tocodynamometer
Timor-Tritsch, I E; Dierker, L J Jr; Hertz, R H; Zador, I; Rosen, M G
1979 ;36(1-2):18-24, Biology of the neonate
A tocodynamometer applied to the maternal abdomen is used for monitoring human fetal respiratory movements (FRM). This provides a recording of fetal chest wall movements from which observations and measurements relating to fetal respiratory physiology may be made. The FRM must be differentiated from materanal vascular and respiratory movements, as well as fetal movements and cardiac pulsations. The technique lends itself to extended periods of observation, since it does not transmit energy to the fetus as in other techniques. The simplicity of the technique, combined with the use of monitoring devices already available in most hospitals, warrants further observation of this method of respiratory movement monitoring in the developing fetus
— id: 76603, year: 1979, vol: 36, page: 18, stat: Journal Article,

Fetal cardiac time intervals and their potential clinical applications
Zador, I E; Wolfson, R N; Pillay, S K; Timor-Tritsch, I E; Hertz, R H
1979 Sep;22(3):651-663, Clinical obstetrics & gynecology
— id: 76599, year: 1979, vol: 22, page: 651, stat: Journal Article,

Studies of antepartum behavioral state in the human fetus at term
Timor-Tritsch, I E; Dierker, L J; Hertz, R H; Deagan, N C; Rosen, M G
1978 Nov 1;132(5):524-528, American journal of obstetrics & gynecology
— id: 76604, year: 1978, vol: 132, page: 524, stat: Journal Article,

Fetal movements associated with fetal heart rate accelerations and decelerations
Timor-Tritsch, I E; Dierker, L J; Zador, I; Hertz, R H; Rosen, M G
1978 Jun 1;131(3):276-280, American journal of obstetrics & gynecology
In normal pregnant women, the relationship between the FHR and fetal movements (FM) was evaluated during 1,541 consecutive observed FM of at least 1 second's duration. Two observed FHR changes were: (1) accelerations and (2) accelerations followed by decelerations. An acceleration in FHR was observed in association with 91.2 per cent of all FM of 1 to 3 seconds' duration and with 99.8 per cent of FM of longer than 3 seconds' duration. FM were associated with an acceleration followed by a deceleration 66.7 per cent of the time. FM lasting longer than 1 second and associated with neither accelerations nor decelerations were seen 1.8 per cent of the time
— id: 76605, year: 1978, vol: 131, page: 276, stat: Journal Article,

Diagnostic studies and fetal assessment in advanced extrauterine pregnancy
Hertz, R H; Timor-Tritsch, I; Sokol, R J; Zador, I
1977 Jul;50(1 Suppl):62s-65s, Obstetrics & gynecology
Advanced extrauterine pregnancy occurs rarely and may present diagnostic difficulty. Failure to induce uterine contractions during oxytocin infusion is a well-established diagnostic technic. The present case suggests that additional newer technics for fetal assessment, including sonography, unstressed monitoring of the fetal heart rate, uterine contractions, fetal movements, and serial urinary estriol determinations may also be useful in diagnosing and managing such complex cas-s
— id: 76607, year: 1977, vol: 50, page: 62s, stat: Journal Article,

Human fetal respiratory arrhythmia
Timor-Tritsch, I; Zador, I; Hertz, R H; Rosen, M G
1977 Mar 15;127(6):662-666, American journal of obstetrics & gynecology
The association of human fetal respiration with the fetal heart rate was studied in 13 pregnant patients between Weeks 34 and 41 of pregnancy. Fetal respiration was recorded with the use of a tocodynamometer. Fetal heart rate was recorded with the use of ultrasound and abdominal fetal electrocardiogram monitoring devices. The results documented the presence of human fetal respiratory arrhythmia. An increase in fetal heart rate was seen during fetal 'inspiration' followed by a decrease during 'expiration.' The possible mechanisms of the respiratory arrhythmia are discussed
— id: 76608, year: 1977, vol: 127, page: 662, stat: Journal Article,

Antenatal investigation of human fetal systolic time intervals
Wolfson, R N; Zador, I E; Pillay, S K; Timor-tritsch, I E; Hertz, R H
1977 Sep 15;129(2):203-207, American journal of obstetrics & gynecology
A noninvasive method for measuring the antenatal human fetal systolic time intervals with the use of the transabdominal fetal electrocardiogram and Doppler cardiogram is described. Unique interactive computer routines were developed for rapid and accurate determination of the pre-ejection period (PEP), ventricular ejection time (VET), PEP/VET ratio, and fetal heart rate (FHR). Thirty normal patients were monitored between 20 and 40 weeks of gestation. A regression analysis of the fetal systolic time intervals and FHR against gestational age was done. PEP and PEP/VET ratio were significantly correlated to the gestational age, while VET and FHR were not
— id: 76606, year: 1977, vol: 129, page: 203, stat: Journal Article,

[Perinatal mortality in breech delivery]
Abramovici, H; Brandes, J M; Peretz, B A; Timor-Tritsch, I; Fuchs, K; Zeltzer, M
1976 Jan 15;90(2):68-71, Harefuah: journal of the Israeli Medical Association
— id: 76611, year: 1976, vol: 90, page: 68, stat: Journal Article,

Electronic monitoring of the fetal heart rate and uterine contractions during cesarean section under balanced anesthesia
Timor-Tritsch, I; Gergely, Z; Abramovici, H; Brandes, J M
1976 Sep;48(3):292-296, Obstetrics & gynecology
The influence of balanced anesthesia (BA) on fetal heart rate (FHR) and uterine contraction (UC) patterns was evaluated in pregnant women undergoing emergency cesarean section. The results showed that during operative delivery under BA there was a significant decrease in the beat-to-beat variability of the FHR, most probably due to the anesthetic agent. There was a decrease in uterine contractility expressed by the significant decreases in the peak pressure as well as in the duration of the uterine contractions. Periodic changes in the FHR as decelerations and acclerations disappeared or improved mostly due to the decrease of uterine contractility
— id: 76610, year: 1976, vol: 48, page: 292, stat: Journal Article,

Classification of human fetal movement
Timor-Tritsch, I; Zador, I; Hertz, R H; Rosen, M G
1976 Sep 1;126(1):70-77, American journal of obstetrics & gynecology
A study of fetal activity was undertaken as the first step in a series of physiologic fetal movement studies. A simple, safe, noninvasive, clinically applicable method for studying fetal movement with a tocodynamometer is described. Four basic types of fetal movement have been seen and defined in terms of their durations, recorded patterns, and descriptive terminologies for identifying each movement
— id: 76609, year: 1976, vol: 126, page: 70, stat: Journal Article,

Miniaturized electrode for on-line PO2 measurements
Eden, G; Inbar, F; Timor-Tritsch, I; Bicher, H I
1975 Jul;22(4):275-280, IEEE transactions on biomedical engineering
— id: 76613, year: 1975, vol: 22, page: 275, stat: Journal Article,

Clomiphene citrate-induced simulatneous intra- and extrauterine pregnancy: case report
Paldi, E; Gergely, R Z; Abramovici, H; Timor-Tritsch, I
1975 Nov;26(11):1140-1140, Fertility & sterility
A rare complication of ovulation induction with clomiphene citrate is presented. The importance of keeping in mind such a serious complication is emphasized in order to achieve early diagnosis and appropriate management. In pregnancies following clomiphene treatment, close supervision is imperative as soon as pregnancy is evident
— id: 76612, year: 1975, vol: 26, page: 1140, stat: Journal Article,

Operative culdoscopy
Paldi, E; Timor-Tritsch, I; Abramovici, H; Peretz, B A
1975 Apr;82(4):318-320, British journal of obstetrics & gynaecology
A study of 257 operative culdoscopies done without general anaesthesia is presented and the advantages and limitations of the technique are detailed
— id: 76614, year: 1975, vol: 82, page: 318, stat: Journal Article,

Tubal pregnancy treated by salpingectomy using operative culdoscopy
Timor-Tritsch, I; Paldi, E
1975 ;54(3):285-286, Acta obstetricia & gynecologica Scandinavica
A case of unruptured Ampullary pregnancy in the 7th postmenstrual week is presented, which was diagnosed and treated at the same time by operative culdoscopy. The indication and advantages of this method are discussed
— id: 76615, year: 1975, vol: 54, page: 285, stat: Journal Article,

Meconium during delivery: a sign of compensated fetal distress
Abramovici, H; Brandes, J M; Fuchs, K; Timor-Tritsch, I
1974 Jan 15;118(2):251-255, American journal of obstetrics & gynecology
— id: 76617, year: 1974, vol: 118, page: 251, stat: Journal Article,

Misleading information from fetal monitoring in a case of intrapartum fetal death
Timor-Tritsch, I; Gergely, Z; Abramovici, H; Brandes, J M
1974 May;43(5):713-717, Obstetrics & gynecology
— id: 76616, year: 1974, vol: 43, page: 713, stat: Journal Article,

Hypno-desensitization therapy of vaginismus. I. "In vitro" method. II. "In vivo" method
Fuchs, K; Hoch, Z; Paldi, E; Abramovici, H; Brandes, J M; Timor-Tritsch, I; Kleinhaus, M
1973 Jul;21(3):144-156, International journal of clinical & experimental hypnosis
— id: 76619, year: 1973, vol: 21, page: 144, stat: Journal Article,

[Surgical culdoscopy in cases of sterilization and of polycystic ovary syndrome]
Paldi, E; Timor-Tritsch, I; Ambramovici, H
1973 Dec;68(12):721-723, Revue francaise de gynecologie et d'obstetrique
The authors describe two types of surgical procedure carried out by means of surgical culdoscopy that have been extensively employed over the past three years at the Rambam Hospital: sterilization by ligation of the tubes ; partial resection of the ovary in the form of a spherical sector in certain cases of polycystic ovary syndrome. The advantages of this method compared with laparotomy and laparoscopy are as follows: it is carried out under local anaesthetic, the technique is simple, there are few complications, and the duration of hospitalization is short
— id: 76618, year: 1973, vol: 68, page: 721, stat: Journal Article,

Operative culdoscopy ad treatment for the polycystic ovary
Paldi, E; Timor-Tritsch, I; Brandes, J M; Peretz, A; Abramovici, H; Fuchs, K
1972 ;17(2):109-110, International journal of fertility
— id: 76620, year: 1972, vol: 17, page: 109, stat: Journal Article,

Male infertility following aortic surgery
Abramovici, H; Weisz, G M; Timor-Tritsch, I; Schramek, A
1971 ;16(3):144-146, International journal of fertility
— id: 76621, year: 1971, vol: 16, page: 144, stat: Journal Article,

Successful treatment of post-partum renal failure with heparin
Timor-Tritsch, I; Better, O S; Tatarsky, I; Chaimowitz, C; Peretz, A; Abramovici, H
1970 Oct 24;4(5729):221-222, British medical journal (1857-1980)
— id: 76622, year: 1970, vol: 4, page: 221, stat: Journal Article,