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Papers by I. Timor-tritsch

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2008

To explore the feasibility and added value of three-dimensional (3D) inversion rendering of the d... more 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. 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. All inversion rendering displays were successful and provided the opportunity to study normal as well as pathological aspects of the early fetal brain. 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.

Ultrasound in Obstetrics and Gynecology, 2000

Ultrasound in Obstetrics and Gynecology, 1993

A total of 230 apparently healthy postmenopausal women underwent transvaginal sonography and pelv... more 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.

Ultrasound in Obstetrics and Gynecology, 2007

Oral poster abstracts fetal anomalies present postnatally corresponded very closely to those diag... more Oral poster abstracts fetal anomalies present postnatally corresponded very closely to those diagnosed prenatally. At 6 hours of life one of the conjoined twins had worsening congestive heart failure and at day 3 of life a successful urgent separation occurred for the pump twin while the anomalous acardiac twin expired. The pump twin continues to do well today but will need further surgical revisions. This is the first case of conjoined twins in which one twin had acardia and the pregnancy was managed with the assistance of Doppler and MRI in addition to ultrasound. To provide optimal treatment for infants with complex anomalies more than one imaging modality may be required and a multidisciplinary team approach is critical. Accurate prenatal diagnosis was critical in our case as urgent intervention was required.

Ultrasound in Obstetrics and Gynecology, 2010

Sirenomelia is a very rare lethal congenital malformation of unknown etiology. The incidence vari... more Sirenomelia is a very rare lethal congenital malformation of unknown etiology. The incidence varies from 0.1 to 0.47/10.000 live births, with a male to female ratio of 3 : 1. To date only 13 cases diagnosed in the first trimester have been reported in the literature. We report the prenatal diagnosis of sirenomelia in a 27 year old woman, gravida 1, who was referred in the 12 th week of gestation because of an intraabdominal cystic structure seen on ultrasound in her local clinic. The mother's family history was noncontributory; she had been treated with levonorgestrel 80 hours after sexual intercourse and with sulfamethoxazole/trimethoprim 14 days after conception because of urinary tract infection. First-trimester scan at 12+4 weeks gestation revealed a malformed fetus with apus (one femur, one small tibia and no feet), intraabdominal unilocular cystic structure measuring 10.8 × 7.3 mm, two-vessel umbilical cord with allantoic cyst measuring 10 mm in diameter. Nuchal translucency measured 1.78 mm, nasal bone was present. Amniotic fluid volume was normal. Prior to termination we performed the chorionic villi vacu-sampling (normal karyotype 46,XY). Transcervical fetoscopy confirmed the ultrasound diagnosis. 3D/4D ultrasound imaging can be advantageous in the process of parental counselling. We suppose that the anomaly could have been associated with the trimethoprim exposure, because of its blocking effect on folic acid.

Journal of Maternal-Fetal and Neonatal Medicine, 2004

Currently, physicians manage preterm premature rupture of membranes (PPROM) by expectant manageme... more 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. 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. 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. This technique for sealing ruptured membranes is effective after amniocentesis, but may not be of benefit with spontaneous rupture.

Ultrasound in Obstetrics & Gynecology - ULTRASOUND OBSTET GYN, 2005

Objective Fecal incontinence affects 0.2% of women aged 15-64 years and about 1.3% of women over ... more 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.

Obstetrics & Gynecology, 1997

To evaluate the feasibility of the detection of ureteral jets into the bladder in obstetric-gynec... more To evaluate the feasibility of the detection of ureteral jets into the bladder in obstetric-gynecologic patients using transvaginal color Doppler ultrasound. 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. 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. 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.

American Journal of Obstetrics and Gynecology, 1994

The aim of the study was to modify a previously devised morphologic scoring system with the use o... more 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. 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. 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. 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.

Ultrasound in Obstetrics and Gynecology, 2003

Objective: To describe pregnancy and epidemiological characteristics of the MFPR at our instituti... more Objective: To describe pregnancy and epidemiological characteristics of the MFPR at our institution. Materials and methods: 290 consecutive cases of MFPR were performed during the years 08/1998-02/2002. The transvaginal route (TVS) was chosen in cases of extreme obesity, patient with abdominal scars and if the fetus in the lowest sac had to be reduced and could not be reached transabdominally (TAS). Prophylactic antibiotics was given. 271 cases were defined as successful by delivery of liveborn babies after 24 postmenstrual weeks of gestation (Group 1). 19 cases had pregnancy losses at, or before 24 weeks (Group 2). Epidemiological as well as pregnancy characteristics were compared. Results: The total pregnancy loss rate was 6.5% (19/290). The loss rate of MFPR by TAS was 3.45% (7/203) and by TVS 13.3 (10/75). Pregnancy losses in relation to starting numbers were was: 4.6% for starting with twins, 7.1% for triplets, 3.3% for quadruplets, 13.6% for quintuplets and 9% for starting number of 6 and above. Pregnancy losses in relation to finishing numbers were: 7.3% for ending with a singleton, 6.3% for twins and 0% for triplets. Parity was higher among Group 1 compared to Group 2 (1.2 ± 0.5 vs. 0.7 ± 1.4, respectively). This difference was statistically significant (p = 0.0001). In Group 1, there was a higher rate of transabdominal reductions compared to Group 2 (72.4% vs. 36.8%). This difference was statistically significant (p < 0.008). No statistical difference was found between the two groups regarding to selective reduction (10% vs. 16%, p = 0.31) respectively.