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We report the case of a massive fetal cardiac rhabdomyoma recently occurred at our clinic. A woman at 23 weeks of gestational age was referred to our center for a fetal cardiac echogenic mass of 26 mm detected at the second-trimester screening ultrasound. During pregnancy, though, the mass progressively increased its dimensions until reaching 48 mm in diameter at 37 weeks of gestation. Fetal echoencephalography and brain magnetic resonance did not show any further fetal anomalies, but molecular genetic testing at amniocentesis revealed a heterozygotic missense variant of gene TSC2 associated with Tuberous Sclerosis. The mass was therefore most likely preferable to a single large rhabdomyoma of gradually increasing dimensions. The baby was delivered at term with a cesarean section. Because of the rhabdomyoma remarkable size and newborn ECG electrical alterations, postnatal therapies with Flecainide and Everolimus were started. Everolimus treatment led to a significant and progressive reduction in the cardiac mass volume. This case, therefore, shows the efficacy of what seems to be a promising treatment in pediatric patients with large rhabdomyomas. Rhabdomyomas may present with different features: most often they appear as multiple masses along the interventricular sept, but they may also appear as a single large thoracic mass. When a rhabdomyoma is suspected, genetic counseling is recommended. Both before and after birth, a multidisciplinary approach is useful to choose the appropriate therapy for the newborn. mTOR inhibitors therapies look like promising therapeutic approaches to stimulate the involution of rhabdomyomas. [ABSTRACT FROM AUTHOR]

Objective: Evaluate two new 3D and two new 2D ultrasound formulae for fetal weight estimation against the modified Hadlock formula and compare their estimation to the actual fetal weight.Methods: Fifty pregnant females were included.Inclusion Criteria: singleton pregnancy, within five days of delivery and normal or IUGR pregnancy. 3D evaluation of the fetal thigh and arm was done to calculate mid-thigh and mid-arm volumes. The actual fetal weight was recorded at delivery and compared to the estimated weights.Results: Modified Hadlock formula had higher accuracy, whereas fractional limb volume method had higher precision. Systematic errors for the modified Hadlock formula, Model 6 of fractional limb volume and the original mid-thigh soft tissue thickness methods were 2.3%, -4.8% and 11%, respectively, whereas the random errors were 7.7%, 6.2% and 13.8%, respectively. The percentage of cases estimated within 5%, 10% and 15% of actual fetal weight were 48%, 86% and 92%, respectively, for the modified Hadlock method, whereas for the fractional limb volume method, these were 40%, 78% and 98%, respectively.Conclusion: Fractional limb volume method is a very promising method for fetal weight estimation. Its performance is not significantly different from the modified Hadlock method. [ABSTRACT FROM AUTHOR]

Objective: Obesity increases the difficulty of completing the fetal anatomic survey. This is of added concern in obese gravidas who are at higher risk of congenital fetal anomalies. We hypothesized that incorporation of an early transvaginal assessment could improve the completion rate of the fetal anatomic survey in obese women. Methods: We performed a prospective, longitudinal, blinded study of obese gravidas (BMI ≥ 35 kg/m2) comparing the use of a single early second trimester transvaginal ultrasound in addition to midtrimester transabdominal ultrasound versus traditional serial midtrimester ultrasound alone for completion of the anatomic survey. Transvaginal ultrasound for anatomy was performed between 13 0/7 and 15 6/7 week followed by midtrimester anatomic ultrasound, with each patient serving as her own control. Structures were marked as optimally or suboptimally viewed after each ultrasound. Sonographers and reviewers were blinded to images from the transvaginal ultrasound. Completion rates and gestational age at completion were compared between groups. Results: Fifty subjects were included. Fetal anatomic survey was completed in 62% using standard midtrimester assessment versus 78% with the addition of early transvaginal assessment (p =.04). The survey was completed at an earlier gestational age utilizing the transvaginal approach (22 0/7 ± 6 3/7) compared to traditional midtrimester transabdominal ultrasound approach (25 2/7 ± 5 3/7) p <.0005. Conclusions: Incorporation of an early transvaginal assessment of anatomy in obese women improved the rate of completion and led to earlier gestational age at completion of the fetal anatomic survey. Consideration should be given to including an early transvaginal sonogram as part of routine assessment of women with a BMI ≥ 35. [ABSTRACT FROM AUTHOR]

Superb Micro-vascular Imaging (SMI; Toshiba Medical Systems, Tokyo) is a new blood flow imaging technique that employs a unique algorithm to minimize motion artifacts by eliminating signals based on analysis of tissue movement. Compared to conventional blood flow imaging such as color and power Doppler imaging, SMI significantly reduces motion artifacts and can visualize low-velocity blood flow in small vessels. In the present report, the clinical value and future potential of SMI in obstetrics have been demonstrated for the first time. We believe this new blood flow imaging technique is acceptable for obstetricians for the purpose of perinatal clinical assessments. [ABSTRACT FROM PUBLISHER]

Objective. To ascertain the impact of placental architecture on antenatal course and labor delivery in a low-risk primigravid population. Methods. This study involves prospective recruitment of 1011 low-risk primigravids with placental ultrasound at 22--24 weeks and 36 weeks. Detailed postnatal review of all mothers and infants was undertaken. Retrospective analysis of ultrasound and clinical outcome data was performed. Results. Eight hundred ten women with complete outcome data were available. Anterior placentation was statistically associated with intrauterine growth restriction (IUGR) and preterm birth and fundal placentation was significantly associated with a higher incidence of pregnancy-induced hypertension and infants with a birthweight less than the 9th centile. Placental infarcts in the third trimester was significantly increased in cases complicated by pre-eclampsia (PET) and in cases with fetal acidosis. Placental calcification was associated a 40-fold increase in the incidence of IUGR. Placental lakes in the second trimester were more prevalent in patients with threatened miscarriage. Increased placental thickness was associated with a higher rate of fetal acidosis. The Grannum grade of the placenta was higher with threatened first or second trimester loss, PET and in infants born less than 9th centile for gestation. Conclusion. Placental site and architecture impact on the incidence of maternal and fetal disease. [ABSTRACT FROM AUTHOR]

Ultrasound machines are nowadays part of the armamentarium of all modern Labor and Delivery Suites. Due to their portability, these machines are ideal for use in emergencies which can occur at any of the labor and delivery rooms. Many of the emergencies in Labor and Delivery can be life threatening; thus, maternal and fetal safety requires efficient and timely ultrasound evaluation. The purpose of this article is to provide guidelines for quick and efficient use of ultrasound based on both the authors' experience and the published literature. [ABSTRACT FROM AUTHOR]

Purpose . To determine the factors that might influence the accuracy of sonographic estimated fetal weight. Study design . A PubMed search (Jan 1975 to Jan 2003) of articles published in the English language was carried out and the inclusion criterion was that estimates were within 10% of birth weight. A Chi-square test for trend was used and odds ratio (OR) with 95% confidence intervals (CI) was calculated. Results . Over 28 years, 175 articles were identified but only 54 (31%) met the inclusion criterion. Overall 62% (8895/14 384) of the predictions were within 10% of the actual weight. The accuracy was significantly different in articles where 7 days were allowed to lapse between examination and delivery (OR 2.17, 95% CI 1.93, 2.45); where examinations were done by registered diagnostic medical sonographers (RDMS; 65%) versus physicians (59%) or residents (57%; p 1000 vs. <1000 cohorts (OR 1.62; 95% CI 1.51, 1.74). Conclusions . If feasible the sonographic examination should be done by RDMS and within a week of delivery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable. [ABSTRACT FROM AUTHOR]

Objective: To determine concordance of ultrasound diagnosis in referrals to a tertiary obstetrical ultrasound unit (TOU) for suspected abnormalities. Study Design: Consecutive referrals for "abnormal outside ultrasound" during a 6-month period were compared with the TOU ultrasound diagnosis. Concordance of diagnosis was compared on the basis of organ system involved and referral for single or multiple suspected abnormalities. Chi(2) analysis was used; p < 0.05 was considered significant. Results: Of 104 consecutive referrals reviewed, 42 (40.4%) had no abnormality documented at the TOU. Of the 62 abnormal ultrasound scans at the TOU, 78.3% were concordant. Concordance based on organ system involvement was central nervous system, 30.3%; cardiothoracic, 66.7%; gastrointestinal, 63.6%; genitourinary, 50%. Referrals for a single suspected anomaly were statistically no more likely to have a normal TOU ultrasound scan (40.4%) than those referred for multiple suspected anomalies (36.4%, p > 0.05). Conclusions: Most referrals to a tertiary center for "abnormal outside ultrasound" will be diagnosed with an abnormality. [ABSTRACT FROM AUTHOR]

Fetal malformations of the central nervous system are among the most common major birth defects encounter during prenatal ultrasound screening. Patients with fetal intracranial findings require further work-up for improving the accuracy of the sonographic diagnosis. We developed and advanced fetal neurosonography and related services to improve clinical care and to positively impact the fetal outcome. Currently, dedicated neurosonography in the prenatal period is not routinely offered across all prenatal diagnostic centers. We propose that dedicated neurosonography done in advanced prenatal diagnostic centers improves fetal outcomes. This is directly related to proper counseling, pediatric and neonatal involvement during the prenatal period. We present here our model of dedicated neurosonography adapted to our center in the last 4 years to improve diagnosis and better understand fetal CNS pathology. With commitment of resources and coordination of services, this model is easy to implement and benefits not only parents and babies but also provides the maternal fetal medicine fellows advanced training in fetal neurosonography. [ABSTRACT FROM PUBLISHER]

In this review we give an overview of the methods and pitfalls in cervical length measurements. We compared the different techniques and investigated factors that influence visualization of the cervix. The data in this overview may be used to establish guidelines in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To compare cervical length measurements obtained by transvaginal two-dimensional (2D) and transvaginal three-dimensional (3D) ultrasound. Study Design: Thirty-four consecutive women having transvaginal assessment of cervical length as part of an obstetric ultrasound examination consented to have a 3D ultrasound scan. The cervical lengths obtained by the two methods were compared by Student's t test and regression equations. Results: The mean cervical 2D length was 35.7 +/- 1.4 (SE) mm and 3D length was 43.7 +/- 1.9 mm (difference 8.0 mm +/- 0.98, p < 0.001). In the 12 women with cervical length on 2D < 35 mm, there was a 7.5 +/- 1.7 (SE) mm difference (p = 0.007). In all but one woman the 3D length obtained was the same or longer than the 2D length. The longer the cervical length on 3D imaging, the greater the difference from the 2D length (p < 0.001). Conclusion: The longer 3D cervical measurements may reflect the inability to measure the cervix adequately with 2D imaging, owing to anatomical factors. This finding may be useful in improving the predictive value of transvaginal ultrasound in assessing the risk for preterm delivery. [ABSTRACT FROM AUTHOR]

Objective. We monitored the fetal heart rate (FHR) during amniocentesis in fetuses at 16--18 weeks of gestation and investigated whether an abnormal FHR is associated with chromosomal abnormalities. Methods. This prospective study involves 807 women at 16--18 weeks of gestation who underwent genetic amniocentesis. The FHR, expressed as beats for minute, is recorded before (FHR1), immediately after (FHR2) and 60 min after (FHR3) the invasive procedure. Structural malformations detected by ultrasound and multiple pregnancy are excluded from the study. Results. Chromosomal abnormalities have been diagnosed in 27 fetuses. A mean FHR decrease after amniocentesis has been observed in normal and in abnormal fetuses. The mean variation during amniocentesis is significant in both groups ( P < 0.01). The comparison between the mean FHR of the two groups shows no differences in FHR1 and FHR2 ( P > 0.05) but a significant difference in FHR3 ( P < 0.05). Conclusion. The FHR decreases after amniocentesis; the decrease is larger in chromosomally abnormal fetuses than in normal fetuses. This difference in heart rate reaction to amniocentesis might be due to cardiac defects or developmental delay associated with the abnormal karyotype. [ABSTRACT FROM AUTHOR]