Die Evaluierung der Dopplersonographie der Aa. uterinae in der 19.-24. Woche zur Vorhersage von Schwangerschaftskomplikationen

Key words: Doppler ultrasonography, uterine artery, hypertension in pregnancy, notch Objective: The objective of the study was to evaluate the screening potential of routine uterine arterial Doppler ultrasonography as a predictor of adverse outcome of pregnancy. Methods: All women (n=602) with unselected pregnancies undergoing a fetal anomaly scan at 19 to 24 weeks of gestation between January 1, 1998 and December 31, 2000 at University Hospital, Technical University of Aachen, Germany were screened for the Resistance-Index (RI) and the presence of an early diastolic notch. Outcome measures included pregnancy induced hypertension, intrauterine growth retardation below 5th centile and preterm delivery before 34 weeks of gestation. Different cutoff values for bilateral RI as 70th, 80th, 90th and 95th centile were examined for the best sensitivity and the lowest false- positive rate at the same time. A uni- or bilateral diastolic notch was also noted in presence and absence of RI greater than 90th centile. Results: Receiver operating curve analysis was used to obtain the best cutoff value for bilateral RI (>0,61) at 80th centile giving the best sensitivity of 44% and a low false-positive rate of 8% at the same time. The positive predictive value (PPV) was 41% and the odds ratio (OR) was 9-times higher. The validity of this optimal cutoff value (bilateral RI>0,61) was investigated in regard to the incidence of pregnancy induced hypertension, intrauterine growth retardation (80th centile) and the other cutoff values the best specifity (98%) with a very high PPV (70%) compared with other results in literature was noted for bilateral RI greater than 0,66 (>90th centile). An additional uni- or bilateral diastolic notch by the presence of the bilateral RI >0,66 improved the specifitiy (99%) and significantly the PPV (76%). Even the relative risk (OR) for the named complications in pregnancy increased by the presence of uni- or bilateral diastolic notch from 27-times to 36-times. Conclusion: A Doppler ultrasonography investigation at 19th to 24th weeks of gestation in a low risk population identified most women who subsequently developed intrauterine growth retardation and preterm delivery followed by pregnancy induced hypertension. From another point of view all women (99%) were identified who were absolutely not at risk to develop a pregnancy induced hypertension or other complications of pregnancy. The early diagnosis of these disorders by Doppler ultrasonography can support an early start of therapy in order to prevent adverse outcome of pregnancy

A tool for integrated design and implementation of conversations in multi-agent systems

Multiagent systems form promising paradigm for software development in complex application domains, but unfortunately tend to be complex systems themselves. The existing gap between analysis and design of multiagent systems and their implementation leads to an increased programming effort. In this paper, we present a graphical tool which tries to bridge this gap by integrating the design and implementation of agent conversations. The tool is implemented, as a plugin, for the integrated development environment Eclipse. Its use follows a conversation programming workflow which supports Agent UML and finite state machines as graphical notations. It is shown how the in-memory representation based on the description language cpXML, is automatically translated into source code for the multiagent framework JADE