Search

Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the performance of QuantusFLM software, which performs quantitative analysis of lung tissue texture through ultrasound images, in predicting lung maturity in fetal growth restriction (FGR). We included patients with singleton gestations between 34 and 38 6/7 wk and divided them into two groups: FGR and control (appropriate for gestational age [AGA]). The images were captured by ultrasound according to a specific protocol up to 48 h before delivery and analyzed with QuantusFLM software. The main clinical outcome evaluated was lung maturity (i.e., the absence of neonatal respiratory morbidity). We included 111 patients; one was excluded because of low image quality, leaving 55 patients in each group. The FGR group had a lower birth weight (2207 g vs. 2891 g, p < 0.001) and a longer stay in the neonatal intensive care unit (NICU) (10 d vs. 5 d, p = 0.043). QuantusFLM software was able to predict lung maturity in FGR with accuracy, sensitivity, specificity and positive and negative predictive values of 94.5%, 96.2%, 50%, 98.1% and 33.3%, respectively. QuantusFLM had good accuracy in predicting lung maturity in FGR with reliability in identifying pulmonary maturity. [ABSTRACT FROM AUTHOR]

The aim of the study described here was to identify an efficient criterion for the prenatal diagnosis of abnormal invasive placenta. We evaluated 129 women with anterior placenta previa who underwent trans-abdominal ultrasound evaluation in the third trimester. Spectral Doppler ultrasonography was performed to assess the subplacental blood flow of the anterior lower uterine segment by measuring the highest peak systolic velocity and resistive index. These patients were prospectively followed until delivery and evaluated for abnormal placental invasion. The peak systolic velocity and resistive index of patients with and without abnormal placental invasion were then compared. Postpartum examination revealed that 55 of the patients had an abnormal invasive placenta, whereas the remaining 74 did not. Patients with abnormal placental invasion had a higher peak systolic velocity of the subplacental blood flow in the lower segment of the anterior aspect of the uterus (area under receiver operating characteristic curve: 0.91; 95% confidence interval: 0.87-0.96) than did those without abnormal placental invasion. Our preliminary investigations suggest that a peak systolic velocity of 41 cm/s can be considered a cutoff point to diagnose abnormal invasive placenta, with both good sensitivity (87%) and good specificity (78%), and the higher the peak systolic velocity, the greater is the chance of abnormal placental invasion. Resistive index had no statistical significance (area under receiver operating characteristic curve, 0.56; 95% confidence interval: 0.46-0.66) in the diagnosis of abnormal invasive placenta. In conclusion, measurement of the highest peak systolic velocity of subplacental blood flow in the anterior lower uterine segment can serve as an additional marker of anterior abnormal invasive placenta. [ABSTRACT FROM AUTHOR]

Abstract: Children with hypoplastic left heart syndrome (HLHS) are at risk for neurodevelopmental dysfunction; prenatal factors may play a role in this predilection. Cerebral blood flow profiles are abnormal in fetuses with HLHS, raising the possibility that cerebral hemodynamics in utero may be related to neurodevelopmental abnormalities. Prenatal aortic valvuloplasty for fetal aortic stenosis with evolving HLHS is technically feasible and improves left heart hemodynamics. This study aimed to assess the effects of prenatal intervention on cerebral blood flow profiles and head circumference in fetuses with evolving HLHS. Seventy fetuses underwent prenatal aortic valvuloplasty for evolving HLHS (median 23 weeks gestation). Among 46 fetuses that had successful valvuloplasty and available data, middle cerebral artery (MCA) pulsatility (PI) and resistive (RI) indices were abnormal (Z-scores –1.7±1.1 and –2.2±1.4, p <0.001). Early post-valvuloplasty (n =33) and at late gestation follow-up (n =28), MCA PI and RI Z-scores remained low with no difference from pre- or early postintervention. Fetal head circumference was normal, as were umbilical artery PI and RI Z-scores. Cerebral blood flow characteristics are abnormal in mid-gestation fetuses with evolving HLHS, suggesting low cerebral vascular impedance. The mechanisms and significance of these abnormalities are unknown. Prenatal aortic valvuloplasty did not have a major impact on these indices. (E-mail: doff.mcelhinney@cardio.chboston.org) [Copyright &y& Elsevier]

Abstract: The purpose of this prospective longitudinal study was to evaluate the growth of the fetal cerebellar volume by means of 3-D ultrasound to evaluate whether there is a difference between the volumes of the left and right cerebellar hemispheres, and to evaluate the intra- and interobserver reliability of two different techniques of volume measurement. Three-dimensional ultrasound examinations were performed every two to three weeks on 27 fetuses between 20 and 40 weeks'' gestation. Measurements of the total cerebellar volume and of the left and right cerebellar hemispheres were done using the multiplanar technique. Multilevel analysis was used to determine the growth of cerebellar volume based on individual developmental trajectories and compare the volume of the right and left hemispheres of the cerebellum. The intra- and interobserver reliability was calculated for the multiplanar and VOCAL™ techniques in a subgroup of 10 fetuses. A nonlinear growth curve of cerebellar volume in normal pregnancy was generated. The cerebellar growth per two-week decreased from a gain of 51% of the first measurement at 20 weeks to a gain of 16% of the first measurement at 38 weeks. The left cerebellar hemisphere was significantly larger (12.3%, p < 0.01) than the right. The intraclass correlation coefficient for the measurements by the two techniques was 0.99. Intraobserver reliability: the intraclass correlation coefficient for the measurements using the multiplanar technique was 0.96 and 0.97 and for VOCAL™ it was 0.98 and 0.97 for the two observers, respectively. Interobserver reliability: the intraclass correlation coefficient for the measurements using the multiplanar technique was 0.97 and for VOCAL™ 0.98. Longitudinal growth curves based on individual developmental trajectories were generated for the cerebellar volume. The left fetal cerebellar hemisphere was found to be significantly larger than the right. Both multiplanar and VOCAL™ techniques had a good intra- and interobserver reliability and yielded very similar results. (E-mail: l.pistorius@umcutrecht.nl) [Copyright &y& Elsevier]

Abstract: We assessed the vascular indices of the anterior territory of the middle cerebral artery (MCA) in normal pregnancies using 3-D power Doppler (3DPD). A cross-sectional study was carried out on 90 normal pregnancies between 24 and 35 weeks. All examinations were performed by a single operator using a volumetric transducer. The anterior territory of the MCA was scanned and the volumes were captured using 3DPD. The sphere mode of the VOCAL program was used to calculate the following vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). Models of polynomial regression and Pearson''s correlation coefficient were used to evaluate the correlation between gestational age (GA) and the vascular indices. The 3DPD vascular indices had a low correlation with gestational age (VI – r = 0.324, p = 0.002; FI – r = 0.375, p < 0.001; VFI – r = 0.374, p < 0.001). There was a low correlation between GA and the 3DPD vascular indices of the anterior territory of the MCA. (E-mail: lunardozza@uol.com.br) [Copyright &y& Elsevier]

Abstract: The objective of this study was to determine if very early ultrasonographic measurements obtained from human and baboon are comparable. For this purpose, the gestational, amniotic and yolk sacs, embryonic crown rump length (CRL) and heart rate were measured ultrasonographically between 35 and 47 days from the mean day of a three-day mating period in baboons (n = 18) and between 42 to 58 days from fertilization as calculated from the CRL measurements in human pregnancies (n = 82). Ultrasonographic measurements from both species were then plotted in the same graph using Carnegie stages of embryonic development as the independent variable to allow for visual comparisons. Mean gestational age at ultrasonographic studies was significantly different for humans and baboons (50.4 vs. 41 days, respectively; p > 0.01). Significant correlations (p > 0.01) were noted between ultrasonographic measurements and Carnegie stages of development in both humans and baboons. Only the gestational and the yolk sacs were significantly smaller in baboons than in humans (p > 0.05). The findings that embryonic CRL, extra-embryonic space and heart rate are very similar between the 17th and 23rd Carnegie developmental stages make the baboon a promising surrogate of human pregnancy for investigations using celocentesis. (E-mail: jsantolaya@partners.org) [Copyright &y& Elsevier]

Abstract: Fetal acrania is uniformly lethal and termination is suggested whenever the diagnosis is made. Traditionally, the diagnostic tool was 2-D ultrasound (US). In this series, we report our work of detecting acrania using 3-D US. We reviewed our medical records of prenatal diagnosis on fetal acrania in National Cheng Kung University Hospital from May 1997 to December 2002. All the cases were scanned by a 3-D US scanner. In total, 29 cases of fetal acrania were diagnosed. The range of gestational age at prenatal diagnosis by US was between 11 and 21 weeks and 44% were depicted in the first trimester. Among them, 93.1% were isolated findings, and one was associated with trisomy 18. Comparing with previous literature, 3-D US can detect fetal acrania as early as 2-D US, and it also can provide additional vivid illustration after various modes of reconstruction, which 2-D US cannot. In conclusion, 3-D US may contribute to early detection of fetal acrania and provide a novel visual depiction of this defect after reconstruction; thus, assists substantially in diagnosis as well as consultation. (E-mail: ahsin@mail.ncku.edu.tw) [Copyright &y& Elsevier]

Diastematomyelia is a rare congenital anomaly where there is complete or partial duplication of the spinal cord as a result of a fibrous, cartilaginous or osseous spur. By 1994 only 100 cases had been reported worldwide. Diagnosis, if prenatal, is usually late 3rd trimester. This poster depicts a case study illustrating ultrasound appearances at 17 weeks gestation and prenatal diagnosis of Diastematomyelia at 24 weeks describing Epidemiology, Presentation, Associated Anomalies, Ultrasound appearances, Treatment and Prognosis. Due to the infrequent presentation and low recorded incidence of Diastematomyelia, limited literature is available on this condition. The purpose of this poster is to rectify this dilemma. 1. To raise awareness of the sonographic appearance of the extremely rare Diastematomyelia. 2. To disseminate the importance of an early diagnosis to promote 'Best Practice Care' and better patient outcomes. 3. To encourage sonographers to be vigilant and ensure thorough scanning. -A thorough obstetric ultrasound examination concentrating on morphology was performed utilising a Toshiba Aplio unit and 10 MHZ and 3.5MHZ curved array transducers. -Maternal and fetal structures were interrogated and documented paying particular attention to the transverse, longitudinal and coronal images of the fetal spine, skin-line and fetal cranium when a spinal abnormality was suspected. -Ultrasound appearances were compared with normal anatomy. Identification of an additional spinal cord posterior ossification centre is pathognomic for ultrasound antenatal diagnosis of Diastematomyelia. The resultant significance of this poster research is to promote earlier diagnosis of this fetal anomaly and associated abnormalities assisting parents with informed decisions concerning obstetric care if their baby is affected by Diastematomyelia. [ABSTRACT FROM AUTHOR]

Isolated sagittal craniosynostosis is the most common premature sutural fusion, but is rarely diagnosed antenatally. There are now a number of reports in the literature describing delivery issues in infants later diagnosed with sagittal synostosis(1-6). The aim of this study was to investigate whether delivery issues are more common in children diagnosed with sagittal synostosis, and identify markers at antenatal ultrasound that could help diagnose the condition before birth. The antenatal ultrasound images of children born in South Australia and the Northern Territory after 1/1/2000 who have diagnosed with isolated sagittal synostosis were compared with antenatal imaging from normal infants without any craniofacial defects. The delivery details from the affected children were also compared to the population delivery data over an extended time period. There was a statistically significantly higher rate of malpresentation and surgical delivery in the sagittal synostosis population. There no significant difference in the cephalic index between the 2 groups at mid trimester morphology scanning. The ultrasound scans showed progressive scaphocephaly during the second half of pregnancy in the affected children while the control population showed minimal change in head shape with a slight tendency towards brachycephaly. 1. Isolated sagittal synostosis typically begins in the second half of pregnancy, and is not detectable antenatally at the mid trimester morphology scan. 2. It is possible to diagnose sagittal synostosis in the third trimester by noting a progressive decrease in the fetal cephalic index, which should provoke 3D ultrasound scanning of the fetal skull to examine the sagittal suture. 3. There is a clear relationship between the presence of sagittal craniosynostosis and breech presentation at delivery in affected fetuses, with a marked increase in the rate surgical deliveries in this group of infants. [ABSTRACT FROM AUTHOR]