Disease diagnosis in horses involves the identification and characterization of illnesses through various diagnostic methods and tools. This process is essential for effective veterinary care and management of equine health. Techniques used in diagnosing diseases in horses include clinical examinations, laboratory tests, imaging modalities such as ultrasonography and radiography, and molecular diagnostics. Blood tests are frequently utilized to assess parameters such as complete blood count and biochemical profiles, which can indicate underlying health issues. Additionally, advancements in genetic testing and biomarker identification have enhanced the ability to detect specific diseases early. This page aggregates peer-reviewed research studies and scholarly articles that explore diagnostic methodologies, their applications, and their impact on equine health management.
Beccati F, Pepe M, Gialletti R, Cercone M, Bazzica C, Nannarone S.Abdominal ultrasonography has become a part of the diagnostic investigation for the acute abdomen in many equine clinics. There is limited information on the correlation between abnormalities detected on abdominal ultrasonography and the specific category of small intestine (SI) and large intestine (LI) diseases. Objective: To investigate the relationship between abdominal ultrasonographic findings and disease categories that cause abdominal pain requiring surgery. Methods: Medical records were reviewed for horses undergoing surgery or post mortem examination for colic. The ultrasound examinat...
Packer MJ, German AJ, Hunter L, Trayhurn P, Proudman CJ.Adipose tissue is an important source of inflammatory cytokines (adipokines) and adiposity has been identified as having a significant effect on human morbidity and mortality. Obesity is also an emerging welfare problem in the UK horse population, but the role that it plays in secondary diseases is unclear. Objective: To examine the expression of inflammation-related adipokine genes in retroperitoneal adipose tissue of horses undergoing emergency abdominal surgery and to explore associations with adiposity and post operative survival. Methods: Retroperitoneal adipose tissue samples were obtain...
Morgan R, Dyson S.Previous descriptions of incomplete longitudinal fractures and fatigue injury of the proximopalmar aspect of the third metacarpal bone (McIII) have focused on diagnostic imaging findings, especially in racehorses. Objective: To document the case details, clinical features, response to diagnostic analgesia, diagnostic imaging findings and follow-up data in a large group of horses with an incomplete longitudinal fracture or fatigue injury of the proximopalmar medial aspect of the McIII. Methods: Horses were included in the study if pain was localised to the proximopalmar aspect of the metacarpal...
Kalemkerian PB, Metz GE, Peral-García P, Lopez-Gappa J, Echeverría MG, Giovambattista G, Díaz S.We investigated the association of equine arteritis virus (EAV) infection and three short tandem repeat (STR) polymorphisms located within or in close proximity to equine lymphocyte antigen (ELA) region. We used a case-control design as a first approach before proceeding to select candidate genes. One hundred and sixty-five Silla Argentino horses were taken in 2002 from positive serological detections of EAV in Argentina, to determine whether STR genotypes were correlated to genetic susceptibility to EVA. Allele frequency distribution did not show significant differences between both groups (P...
Quintana AM, Hussey SB, Burr EC, Pecoraro HL, Annis KM, Rao S, Landolt GA.To evaluate whether an equine-derived canine H3N8 influenza A virus was capable of infecting and transmitting disease to ponies. Methods: 20 influenza virus-seronegative 12- to 24-month-old ponies. Methods: 5 ponies were inoculated via aerosol exposure with 10(7) TCID(50) of A/Canine/Wyoming/86033/07 virus (Ca/WY)/pony. A second group of 5 ponies (positive control group) was inoculated via aerosol exposure with a contemporary A/Eq/Colorado/10/07 virus (Eq/CO), and 4 sham-inoculated ponies served as a negative control group. To evaluate the potential for virus transmission, ponies (3/inoculatio...
Quist EM, Dougherty JJ, Chaffin MK, Porter BF.A 1.5-year-old Quarter Horse gelding with a history of chronic nasal discharge and leukocytosis presented with signs of increased lethargy and muscular pain. The horse quickly became recumbent and unable to rise and was euthanized due to a poor prognosis. At necropsy, severe bilateral guttural pouch empyema was observed, as well as numerous well-demarcated areas of pallor within the skeletal muscles of all major muscle groups. Polymerase chain reaction testing of the guttural pouch exudate confirmed an infection with Streptococcus equi subsp. equi, and an S. equi-associated immune-mediated rha...
Parmar J, Winterbottom A, Cooke F, Lever AM, Gaunt M.Streptococcus equi is a common equine infectious disease, but transmission to man is rare and confined to those who commonly come into close contact with horses. Similarly, prosthetic stent graft infection is a rare complication of endovascular aortic aneurysm repair. We describe the first reported case of aortic stent graft with S. equi occurring in a professional racehorse trainer. Clinical presentation, investigations, imaging and management of this case are described. In conclusion, clinicians should consider infection with rare organisms in patients with prosthetic implants who regularly ...
Faleiros RR, Leise BS, Watts M, Johnson PJ, Black SJ, Belknap JK.Chemokines play a vital role in leukocyte activation and emigration that reportedly plays a central role in laminar injury in equine laminitis. The purpose of this study was to evaluate the pattern of laminar chemokine expression in horses in the classical carbohydrate overload (CHO)-model of laminitis. Laminar samples were obtained 24h following water administration in the control group (CON, n=8), and at the onset of fever (≥ 102°F, 12-22 h post CHO, DEV group, n=8) and at the onset of lameness (20-48 h post CHO, LAM group, n=8) in induced horses. Real time quantitative PCR was performed ...
Marfe G, Massaro-Giordano M, Ranalli M, Cozzoli E, Di Stefano C, Malafoglia V, Polettini M, Gambacurta A.Stem cell technology has evoked considerable excitement among people interested in the welfare of animals, as it has suggested the potential availability of new tools for several pathologies, including eye disease, which in many cases is considered incurable. One such example is ulcerative keratitis, which is very frequent in horses. Because some of these corneal ulcers can be very severe, progress rapidly and, therefore, can be a possible cause of vision loss, it is important to diagnose them at an early stage and administer an appropriate treatment, which can be medical, surgical, or a combi...
Johnstone LK, Mayhew IG, Fletcher LR.Perennial ryegrass staggers is purported to be a common neurological mycotoxicosis of horses but the case description lacks detail and evidence. Objective: To describe the clinical syndrome of lolitrem B intoxication in horses, limiting tests to those that are applicable to clinical practice, and to assess the potential value of enzyme-linked immunosorbent assay (ELISA) tests for lolitrem B in horse body fluids. Methods: Seven horses in 2 separate groups were fed perennial ryegrass seed and hay containing 2 ppm lolitrem B. Paired data were collected prior to and after 2 weeks exposure to lol...
Biggi M, Dyson S.The significance of distal border fragments of the navicular bone is not well understood. There are also no objective data about changes in thickness and proximal/distal extension of the palmar cortex of the navicular bone. Objective: To describe the distribution of distal border fragments and their association with other radiological abnormalities of the navicular bone and describe the shape of the navicular bone in sound horses and horses with foot-related lameness, including navicular pathology. Methods: Sound horses had radiographs acquired as part of a prepurchase examination. Lame horses...
Fraipont A, Van Erck E, Ramery E, Richard E, Denoix JM, Lekeux P, Art T.Thirty-eight endurance horses underwent clinical and ancillary examinations, including haematological and biochemical evaluation, standardised exercise tests both on a treadmill and in the field, Doppler echocardiography, impulse oscillometry, video endoscopy and collection of respiratory fluids. All of the examined poorly performing horses were affected by subclinical diseases, and most of them had multiple concomitant disorders. On the contrary, the well-performing horses were free of any subclinical disease. The most frequently diagnosed diseases were respiratory disorders, followed by musc...
Visser MB, Pollitt CC.Laminitis is known to involve deregulation of proteases and destruction of the lamellar basement membrane with the host inflammatory response also playing a role. Leukocyte infiltration has been well characterized in the black walnut model of laminitis induction, but not in carbohydrate induced models. Increased gene expression of multiple cytokines, including IL-6, has also been implicated in laminitis development. Using real time PCR, immunohistochemistry and zymography methods, we characterize leukocyte infiltration and IL-6 gene expression in oligofructose (OF) induced laminitis. As well, ...
Hess IM, Massey PD, Walker B, Middleton DJ, Wright TM.Hendra virus infection is an emerging infectious disease that is not well understood. Most cases of Hendra virus infection have occurred in Queensland, with one case in a horse in NSW. Hendra virus infection has a high mortality rate in horses and humans and as cases could occur anywhere in Australia it is important to be ready for prompt action should an outbreak occur in NSW. This paper: reviews the current knowledge on Hendra virus infection including methods for preventing the disease; explains the animal health and human health response for an outbreak within NSW; and discusses possible f...
Fall AG, Diaïté A, Etter E, Bouyer J, Ndiaye TD, Konaté L.Active catches of adult females of Aedes vexans arabiensis Patton, (Diptera: Culicidae) Patton by nets or aspirator, were conducted in 2003 and 2004 in the vegetation at the edge of temporary ponds in Barkedji, Senegalese Ferlo area. Two hundred and forty-one engorged females were captured, dissected and the gut content adsorbed on a Whatman filter paper and analysed using the enzyme-linked immunosorbent assay (ELISA) technique to determinate the bloodmeal origin. Results indicated that Ae v. arabiensis fed primarily on mammals, including horses (35.7% of the bloodmeals), but also on birds (10...
Ribera T, Monreal L, Armengou L, Ríos J, Prades M.Increased synovial fibrinolytic activity (detected by increases in synovial D-Dimer concentrations) has been observed in different joint diseases in humans and adult horses, presumably in order to minimize fibrin deposition within the joint and thus avoid its detrimental effects. Objective: To investigate fibrinolytic pathway activation in joint sepsis in foals by measuring synovial D-Dimer concentrations. Methods: Eighteen septic foals with septic joints, 9 septic foals without septic joints, 9 systemically healthy foals with septic joint, and 3 controls are included. Methods: Prospective obs...
Trachsel DS, Grenacher B, Weishaupt MA, Schwarzwald CC.Atrial natriuretic peptide (ANP) is a cardiovascular biomarker that might be useful in assessing the severity of cardiac disease in horses. Plasma ANP concentrations (Cp(ANP)) were compared between horses with heart disease but normal chamber size and function (Group A; n=6), horses with heart disease associated with left atrial (LA) enlargement, LA dysfunction, and/or left ventricular (LV) enlargement (Group B; n=5), and horses with no clinically apparent cardiovascular disease (Group C; n=13). The median (min-max) for Cp(ANP) was significantly higher in Group B (53.5 (36.0-70.7) pg/mL), comp...
Pathania VP, Sharma AK, Joshi GR, John JT.India accounts for approximately 10 million orthopaedically handicapped children and adults with limb deformity. Ilizarov ring fixator could treat most of these deformities. Methods: Twenty cases of deformities of lower limb managed with Ilizarov technique during period between March 2001 and February 2003 were studied. Results: 55% were in the age group of 11-30 years. Out of the 20 cases studied, 6 were congenital talipes equino varus, 8 were fixed flexion deformity of knee, 4 were equines deformity of the ankle and 2 were malunited fracture shaft of tibia.4 patients who had recurrence were ...
Burbelo PD, Bren KE, Ching KH, Coleman A, Yang X, Kariu T, Iadarola MJ, Pal U.Infection with Borrelia burgdorferi is common in horses and ponies from the New England and mid-Atlantic regions of the United States. Here, we evaluated luciferase immunoprecipitation systems (LIPS) for profiling antibody responses against three different antigenic targets for the diagnosis of equine B. burgdorferi infection. LIPS testing of horse serum samples suspected of Lyme infection revealed that approximately 75% of the horse samples (114/159) were seropositive against the synthetic VOVO antigen, comprising repeated immunodominant C6 epitopes as well as OspC immunodominant epitopes. A ...
Yuan Z, Gault EA, Campo MS, Nasir L.Equine sarcoids represent the most common skin tumours in equids worldwide, characterized by extensive invasion and infiltration of lymphatics, rare regression and high recurrence after surgical intervention. Bovine papillomavirus type 1 (BPV-1) activity is necessary for the transformation phenotype of equine fibroblasts. Among the many changes induced by BPV-1, matrix metalloproteinase 1 (MMP-1) upregulation contributes to the invasiveness of equine fibroblasts. However, it is not yet known how BPV-1 proteins regulate equine MMP-1 expression. To elucidate this mechanism, the equine MMP-1 prom...
Wernery U, Wernery R, Joseph M, Al-Salloom F, Johnson B, Kinne J, Jose S, Jose S, Tappendorf B, Hornstra H, Scholz HC.We confirm a natural infection of dromedaries with glanders. Multilocus variable number tandem repeat analysis of a Burkholderia mallei strain isolated from a diseased dromedary in Bahrain revealed close genetic proximity to strain Dubai 7, which caused an outbreak of glanders in horses in the United Arab Emirates in 2004.
Dechant JE, Symm WA, Nieto JE.To compare agreement between a portable clinical analyzer and laboratory-based bench-top analyzer for analysis of pH, lactate, and glucose concentrations in synovial fluid. Methods: Prospective experimental study. Methods: Clinically normal horses (n=8); 6 horses euthanatized for reasons unrelated to the study; 11 horses that had synoviocentesis for reasons other than sepsis; 7 horses that had synoviocentesis for evaluation of sepsis; and 2 horses without recorded clinical data. Median age of horses was 8 years (range, 1 day to 24 years). Methods: Supernatant from each synovial fluid sample wa...
Parker RA, Yeates JW.Assessing patients' quality of life (QOL) is a core part of clinical decision making. Various methodologies for assessing patients' QOL have been developed in human medicine and small animal veterinary disciplines. In contrast, the lack of aids for QOL assessment in equine veterinary practice leaves practitioners reliant on subjective assessments of QOL, which may be prone to avoidable errors. Objective: This paper suggests pragmatic ways in which QOL may be enhanced, while remaining appropriate for the time, financial and owner-based constraints within equine practice. Methods: Through interd...
Bountouri M, Fragkiadaki E, Ntafis V, Kanellos T, Xylouri E.For first time in Greece equine influenza virus infection was confirmed, by isolation and molecular analysis, as the cause of clinical respiratory disease among unvaccinated horses during 2003 and 2007 outbreaks. Methods: Equine influenza virus (EIV) H3N8 was isolated in MDCK cells from 30 nasal swabs from horses with acute respiratory disease, which were tested positive by Directigen Flu A. Isolation was confirmed by haemagglutination assay and RT-PCR assay of the M, HA and NA gene. Results: HA sequences of the Greek isolates appeared to be more closely related to viruses isolated in early 19...
Lin YZ, Cao XZ, Li L, Li L, Jiang CG, Wang XF, Ma J, Zhou JH.The attenuated equine infectious anemia virus (EIAV) vaccine was the first attenuated lentivirus vaccine to be used in a large-scale application and has been used to successfully control the spread of equine infectious anemia (EIA) in China. To better understand the potential role of cytokines in the pathogenesis of EIAV infection and resulting immune response, we used branched DNA technology to compare the mRNA expression levels of 12 cytokines and chemokines, including IL-1α, IL-1β, IL-4, IL-10, TNF-α, IFN-γ, IP-10, IL-8, MIP-1α, MIP-1β, MCP-1, and MCP-2, in equine monocyte-derived mac...
Kumar S, Malik P, Verma SK, Pal V, Gautam V, Mukhopadhyay C, Rai GP.Glanders, caused by the Gram-negative, nonmotile bacterium Burkholderia mallei, is a contagious and highly fatal disease of equines. During the last decade, the number of glanders outbreaks has increased steadily. The disease also has high zoonotic significance and B. mallei is listed biological warfare agent. The complement fixation test (CFT) is a routinely used and internationally recognized test to screen equine sera for the glanders. However, discrepant results have been observed using the CFT. The low sensitivity and specificity of the CFT and enzyme-linked immunosorbent assay (ELISA) ha...
Lin ST, Bolas NM, Sargan DR, Restif O, Peter VG, Pokora R, Patrick H, Foote AK, Murray RC.Dorsoproximal osteochondral defects commonly affect the proximal phalanx, but information about diagnosis on computed tomography (CT) and magnetic resonance imaging (MRI) is limited. Objective: To assess CT and MRI diagnoses of osteochondral defects, describe the lesions and compare sensitivity and specificity of the modalities using macroscopic pathology as gold standard. Methods: Cross-sectional study. Methods: Thirty-five equine cadaver limbs underwent standing cone-beam CT (CBCT), fan-beam CT (FBCT), low-field MRI and pathological examination. CT and MR images were examined for proximal ph...
Pimenta J, Pires I, Prada J, Cotovio M.Melanocytic tumors are an important neoplastic disease in human and veterinary medicine, presenting large differences regarding tumor behavior between species. In horses, these tumors present a prolonged benign behavior, with rare invasiveness and metastases. In humans and small animals, invasion and metastasis have been associated with an Epithelial-Mesenchymal Transition, where the loss of E-cadherin expression plays a key role in tumor progression. This process and the role of E-cadherin have not yet been evaluated in equine melanocytic tumors. This study aimed to assess the immunolabeling ...
Jahrling PB, Beall JL.Hydroxylapatite column chromatography methods were developed to characterize selected alphavirus populations. Different conditions of pH and phosphate molarity were required to obtain satisfactory elution profiles and separations for Western equine encephalomyelitis virus strains, compared with Eastern equine encephalomyelitis virus and Semliki Forest virus strains. Raising the pH of the buffers effected earlier elutions of all viruses. Selection of phosphate gradients with more gentle slopes and adjustment to the proper pH effected better separations of virus subpopulations. Elution profiles ...
Hopster K, Wogatzki A, Geburek F, Conze P, Kästner SB.High airway pressures, necessary to keep equine lungs open, can have a detrimental impact on central and peripheral perfusion. Objective: The aim of this study was to assess the effects of stepwise increasing airway pressure recruitment on central and intestinal perfusion and oxygenation during isoflurane anaesthesia in horses. Methods: In vivo experimental study. Methods: Ten anaesthetised horses were ventilated using intermittent positive pressure ventilation immediately after induction. After 90 min, end-expiratory pressure (PEEP) was increased by steps of 5 cmH2 O every 10 min up to a PEEP...
Caol S, Divers T, Crisman M, Chang YF.Lyme disease in humans is predominantly treated with tetracycline, macrolides or beta lactam antibiotics that have low minimum inhibitory concentrations (MIC) against Borrelia burgdorferi. Horses with Lyme disease may require long-term treatment making frequent intravenous or intramuscular treatment difficult and when administered orally those drugs may have either a high incidence of side effects or have poor bioavailability. The aim of the present study was to determine the in vitro susceptibility of three B. burgdorferi isolates to three antibiotics of different classes that are commonly us...
Power HT, Watrous BJ, de Lahunta A.In 6 horses, clinical signs of illness implicated a lesion involving the facial and vestibulocochlear nerves. One horse had signs of otitis externa. Five horses had radiographic changes primarily involving periosteal bony proliferation of the stylohyoid bone at its articulation with the temporal bone. Five horses improved with antibiotic therapy. Otitis media-interna was found at necropsy of one horse.
Karam B, Hines S, Skipper L, Pusterla N.Serum amyloid A (SAA) is considered a major acute phase protein (APP) in horses. Serum amyloid A stall-side assays are commercially available to assess the inflammatory response of patients with various infectious and noninfectious conditions. The objective of this study was to determine the analytical performance of a new point-of-care (POC) assay for the measurement of SAA in whole blood and plasma of horses. One hundred and sixty blood samples were collected from 60 horses at various time points after immunization with an equine core vaccine. Analytical validation of the SAA POC assay inclu...
Sanz MG, Oliveira AF, Loynachan A, Page A, Svansson V, Giguère S, Horohov DW.Rhodococcus equi (Rhodococcus hoagii/Prescottella equi) is a common cause of foal pneumonia, but its diagnosis remains a challenge for equine veterinarians. While the VapA-specific (virulence-associated protein A) immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) has low sensitivity and specificity for detecting pneumonic foals, little is known about VapA-specific IgG subclasses. Objective: To evaluate the performance of VapA-specific ELISA for IgG and its subclasses IgGa, IgGb and IgG(T) in the early diagnosis of pneumonia caused by R. equi. Methods: Assay validation follow...
Benvegnen J, De Breuyn B, Gerber V, Rottenberg S, Koch C.The aim of the study was to assess the expression of the immune checkpoint inhibitor programmed death-ligand 1 (PD-L1) in equine sarcoids (ES). Programmed death-ligand 1 is expressed by various cancer cells to block T cell-mediated elimination of tumor cells. Antibodies targeting human PD-L1 were tested by immunohistochemistry for their cross-reactivity with equine PD-L1 using formalin-fixed, paraffin-embedded tissues. Our results do not support an important role of PD-L1-mediated immune evasion in ES disease and hence do not offer a rationale for anti-PD-1/PD-L1-based immunotherapy against ES...
Nelissen S, Miller AD.Granulosa cell tumors (GCTs) are common ovarian neoplasms in the mare and bitch that can be challenging to diagnose on histopathology. Inhibin has long been the standard immunohistochemical (IHC) marker for GCTs; however, anti-Müllerian hormone (AMH) has not been evaluated widely as an IHC marker in the bitch and mare. We compared the efficacy of AMH and inhibin as IHC markers in canine and equine GCTs. We selected retrospectively 18 equine and 15 canine cases. All equine tumors were dominated by a cystic pattern; canine tumors often had solid patterns. Both inhibin and AMH had similar puncta...
Borba LA, Nogueira CEW, Bruhn FRP, da Silva GC, Feijó LS, Canisso IF, Curcio BDR.Neonatal sepsis is a leading cause of neonatal death during the first-week postfoaling. Despite recent advancements in the diagnosis and treatment of sepsis in the newborn foal, the non-specific clinical signs and subtle nature of this disease may result in delayed diagnosis until severe progression of the disease; thus, early detection of sepsis remains critical for a favourable outcome. This study aimed to identify early blood markers as predictive of sepsis on foals. Thirty-five foals were allocated into three groups: healthy control foals (n=7) and foals born from mares with placentitis: s...
Niedermaier G, Wollanke B, Hoffmann R, Brem S, Gerhards H.Equine recurrent uveitis (ERU) is caused by persistent intraocular leptospira, which appear to use the vitreous body as a refuge. The detection of leptospira in the vitreous body of horses with spontaneous ERU by histological methods has not yet been described. Thirty eight vitreous body samples from 36 horses with ERU (collected during vitrectomy), and 10 vitreous body samples obtained from 5 horses without ocular disease (control group) were examined by transmission electron microscopy. Prior to sample collection, 2 ml of a leptospira culture suspension were injected into the vitreous body o...
Cray C, Perritt E, Hughes C, Belgrave RL.Encephalitozoon cuniculi is an obligate intracellular microsporidian parasite that can result in clinical and subclinical infection in many species. In the present study, a serological survey was conducted using samples from 105 horses in the state of New Jersey; 49 of the samples were obtained from clinically abnormal animals. Five or 4.8% of 105 serum samples were found to demonstrate reactivity by ELISA with titers of 1:64 to 1:1,024. One of the samples was obtained from a clinically normal horse. Clinical signs and diagnoses from the other animals included lameness, colic, osteochondritis ...
Roccabianca P, Paltrinieri S, Gallo E, Giuliani A.A 21-year-old Dutch crossbred mare was presented with a 1-month history of weight loss and weakness. Clinical evaluation revealed severe anemia and thrombocytopenia with evidence of hepatic disease and muscular damage. Necropsy findings included diaphragmatic rupture with an extensive retroperitoneal hematoma and severe hepatosplenomegaly. Microscopic findings were characterized by hepatic sinusoidal and splenic red pulp infiltration by atypical CD3-positive lymphocytes. No other nodal or extranodal sites were affected. Hepatosplenic lymphoma with a probable T-cell origin was diagnosed based o...
Jiménez D, Romero-Zuñiga JJ, Dolz G.Blood samples from 181 equines from the Central Valley of Costa Rica were collected in the year 2012 to determine the presence of antibodies against selected infectious agents in horses and to determine the risk factors associated with these agents. The presence of antibodies against Equine Infectious Anemia Virus (EIAV), Equine Herpes Virus 1 and 4 (EHV-1 and EHV-4), West Nile Virus (WNV), Influenza A Virus (IAV), Equine Viral Arteritis Virus (EVAV), Babesia caballi, Theileria equi, Neospora caninum and Chlamydia abortus was determined using commercial assays, and risk factors associated with...
Kimura Y, Haneda S, Aoki T, Furuoka H, Miki W, Fukumoto N, Matsui M, Nambo Y.The combined thickness of the uterus and placenta (CTUP) and ultrasonographic images of uteroplacental tissues were investigated in 35 pregnant heavy draft horses in Months 7-12 of pregnancy. The mares were divided into three groups: those pathologically diagnosed as placentitis (placentitis group, n=3); those who had abortion, premature birth, or fetal malformation (abnormal group, n=7); and those who had no abnormal findings (normal group, n=25). In the normal group, CTUP increased as pregnancy progressed from Months 7 (median, 7.08 mm; range, 5.68-11.27) to 12 (13.31 mm; 7.44-16.31 mm) (P<0...