A total of 834 women with uneventful pregnancies were followed prospectively until the 15th week of gestation by TVS to screen for early embryonic malformations. Twenty-eight embryonic anomalies were detected in this series (3.3% ). The median gestational age at diagnosis was 11 (range, 8 to 15) weeks. Two neural tube defects were missed by early TVS screening. Two suspected abdominal wall defects were not confirmed by repeat mid-second trimester abdominal sonography representing 6.7% of all fetal malformations evident by 24 weeks of gestation. The sensitivity and specificity of TVS screening for fetal malformations in this series were 93.3 and 99.7%, respectively. In addition, the role of TCDU also was investigated in these 28 abnormal embryos. TCDU proved to be of

A total of 108 cases of small perimenopausal ovarian tumors (largest diameter, less than 7 cm) were evaluated by transvaginal sonography and duplex color Doppler sonography; 101 had criteria for benignity and 7 for malignancy. All cysts were punctured and aspirated to avoid unnecessary surgery (benign cases) and establish the cytologic diagnosis as well as to avoid the risk of leakage (malignant cases). Recurrence rate of benign punctured cysts was 25% within 1 year of follow up. No difference in recurrent rate was seen between pre- and postmenopausal patients (19 of 56 cases in the premenopausal group, and five of 28 cases in the postmenopausal group). The larger the cyst, the greater the risk of recurrence. Puncture and aspiration of seven sonographically established malignant tumors allowed cytologic diagnosis before surgery, and no evidence of leakage was noted at the time of surgery. No significant differences were observed between cytologic and histopathologic findings in cases that went to surgery. Puncture and aspiration of small endometriomas (17 cases) was found to be inefficient for therapeutic purposes. Finally, owing to the high percentage of unsatisfactory cytologic results (20%) with cyst aspiration, vaginal and color Doppler sonography seemed more efficient in distinguishing between benignity and malignancy.

We used transvaginal color Doppler sonography to study the effect of hormone replacement on the uterine arterial blood flow of 203 postmenopausal women. The regimens studied involved estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by combined estrogen-progestogen. The mean pulsatility index fell to 65% ± 9% and the mean resistive index fell to 87% ± 4% of baseline during E pidemiologic data indicate that HRT has a protective effect against coronary artery disease in postmenopausal women. It has been suggested that HRT has a "nonmetabolic or direct vascular effect" on arterial tone.t The mechanism by which HRT might influence arterial tone remains uncertain. Although there is some evidence that estrogens have such an effect,2· the vascular effects of HRT have not been well defined. In addition, although some studies have addressed the influence of progestogens on the beneficial vascular effects of estrogens, the effects on vascular flow of adding progestogens to HRT have not yet been determined objectively in humans. We found no reports in the literature on whether there was a difference in vascular response to HRT if progestogens were added to estrogen at the onset of therapy or if they were added sequentially.PI and RI are indicators of resistance to flow distal to the point of measurement. The higher the value of these indices, the greater the resistance to flow, and vice versa. The ability to measure PI and RI with great accuracy using color imaging has made possible a more thorough and systematic evaluation of the vascular response to HRT in humans. Preliminary reports6 indicate that the vascular benefits of HRT remain effective during several months of treatment, but the overall impact of long-term hormonal use is still unknown.

We used transvaginal color Doppler sonography to study the effects of hormone replacement therapy on the endometrial structure and vascular flow of 345 normal postmenopausal women. We studied women taking estrogen replacement alone, continuous combined estrogen and progestogen, and estrogen followed sequentially by estrogen-progestogen combination. Endometrial measurements prior to the initiation of hormone replacement therapy were used as baseline values. An increase in endometrial thickness was seen soon after initiation of hormone replacement therapy (P < 0.0001). Hyperplasia or adenocarcinoma was found only when endometrial thickness was greater then 9 mm. No correlation was found between hormone replacement therapy and the occurrence of endometrial hyperplasia or adenocarcinoma.

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