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Re: Yolk sacFrom: dr. amit sengupta (asengup@tm.net.my)Fri Jan 29 03:05:33 1999
I find the discussion very interesting so far and would like everyone to ponder if we can converge on the issue brought over by Terry. Quite often we clinicians venture into studies not knowing the basic physics and its application. Once the physics is understood, limitations are clear and we modify the entire procedure all over again. Now for yolk sac problem, we have to ask certain questions to ourselves? Is the physics of yolk sac development or regression as per the geometry and the density of the sac lining clear to us? What we intend to achieve if it is known? I have been looking into yolk sac for quite some time but still not quite at ease with its actual application in practice. I think it will be great to find some correlation in future. If I have correctly understood, the whole purpose of this or any other screening marker is to either predict, detect or define chromosomal aberrations and congenital malformation or impending embryonic demise etc. The sole objective is to terminate, intervene or rectify the problem. Now the Questions for future thought?. What is the sensitivity /specificity of YS measurement vis a vis CRL/ weeks of gestation with respect to above mentioned before 10 weeks of gestation? Is it possible to pin point chromosomal aberrations without CVS or amnio/DNA probe for sure? Can this replace or be a reliable guide to carryout CVS/amnio/DNA probe? If yes, how much standard deviation should be the allowed ? Say we find it quite useful, Can we on the basis of YS measurement advice the preg. mothers to go for termination of pregnancy? Can we detect in actual term for sure the specific congenital malformation using the index? The reason being that the structural abnormalities are apparent sonographically after 14-16 weeks of gestation . The organogenesis starts after 8-9 weeks of gestation. Another routine problem I face even though the answer is bit futuristic but I will invite discussion and view point. I worked in countries where termination/abortion is illegal due to religious belief? Whenever I ask them on the basis of all the possible tests (USG, biochemical, genetic) to think about possible termination, they refuse and pose interesting question. Is it's possible to correct the chromosomal/congenital aberrations in utero at very early pregnancy, say before 12-14 weeks of gestation? To me the answer lies in genetic engineering. It would be interesting to initiate discussion on this viv a vis YS measurement and its usefulness in detecting or intervining early pregnancy fetal problem or demise. Dr.Amit Sengupta,MBBS,MD,Ph.D OBGY spl & Biomed.Engg researcher,India. -----Original Message----- From: DuBose, Terry <DuboseTerryJ@exchange.uams.edu> To: Multiple recipients of list <ultrasound@talk.obgyn.net> Date: Thursday, January 28, 1999 6:35 AM Subject: Re: Yolk sac
>The physics of specular echoes would indicate the leading edge method
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