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Objective: To determine how often the embryo implants exactly at the site of transfer and what additional factors may affect the eventual site of implantation in assisted reproductive technology (ART) cycles.Methods: This was a prospective observational study of women undergoing ART treatment in a tertiary university unit. Several factors inherent to the embryo transfer (ET), such as the location of the air bubbles and uterine contractility at 1 and at 60 min after ET were assessed with two-dimensional and three-dimensional (3D) ultrasound. In women in whom there was a resulting pregnancy, the position of the gestational sac (i.e. right, left, center or low) was subsequently assessed using 3D ultrasound, and predictors of its location were evaluated.Results: Of 239 recruited women with visualization of air bubbles at ET, 71 singleton gestational sacs were subsequently observed on 3D ultrasound. Overall, 40.8% (29/71) of embryos implanted at the location where the air bubbles were visualized at 1 min after ET, and 50.7% (36/71) implanted where the air bubbles were visualized at 60 min after ET (Cohen's kappa coefficients 0.21 and 0.37, respectively; comparison of agreement values: P = 0.28). Specifically, at 1 min the correspondence between the location of the air bubble and embryo implantation was 37.5% (6/16), 57.1% (8/14), 36.8% (7/19) and 36.4% (8/22) for right, left, central and lower uterus, respectively (4 × 4 contingency table, P < 0.01); at 60 min, the correspondence was 72.2% (13/18), 50.0% (9/18), 33.3% (8/24) and 85.7% (6/7), respectively (5 × 4 contingency table, P < 0.001). In addition, higher vs lower frequency of uterine contractions at 60 min was associated with different sites of implantation (5.6% (1/18), 11.1% (2/18), 27.8% (5/18) and 55.6% (10/18) vs 34.0% (18/53), 24.5% (13/53), 13.2% (7/53) and 28.3% (15/53) for right, left, central and lower uterus, respectively, P < 0.05). In particular, a high uterine contraction frequency following ET was associated with a twofold increased chance of the pregnancy implanting in the lower part of the uterine cavity (relative risk, 1.96 (95% CI, 1.08-3.56), P < 0.05).Conclusions: The position of the air bubbles within the first 60 min of ET appears to predict the site of implantation in approximately half of cases, denoting an overall poor agreement. This implies significant embryo migration, and has important clinical implications, as it demonstrates that other factors such as uterine contractility may dictate where the embryo will eventually implant following transfer. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

'Manual navigation' by the operator is the standard method used to obtain information from two-dimensional and volumetric sonography. Two-dimensional sonography is highly operator dependent and requires extensive training and expertise to assess fetal anatomy properly. Most of the sonographic examination time is devoted to acquisition of images, while 'retrieval' and display of diagnostic planes occurs rapidly (essentially instantaneously). In contrast, volumetric sonography has a rapid acquisition phase, but the retrieval and display of relevant diagnostic planes is often time-consuming, tedious and challenging. We propose the term 'intelligent navigation' to refer to a new method of interrogation of a volume dataset whereby identification and selection of key anatomical landmarks allow the system to: 1) generate a geometrical reconstruction of the organ of interest; and 2) automatically navigate, find, extract and display specific diagnostic planes. This is accomplished using operator-independent algorithms that are both predictable and adaptive. Virtual Intelligent Sonographer Assistance (VIS-Assistance®) is a tool that allows operator-independent sonographic navigation and exploration of the surrounding structures in previously identified diagnostic planes. The advantage of intelligent (over manual) navigation in volumetric sonography is the short time required for both acquisition and retrieval and display of diagnostic planes. Intelligent navigation technology automatically realigns the volume, and reorients and standardizes the anatomical position, so that the fetus and the diagnostic planes are consistently displayed in the same manner each time, regardless of the fetal position or the initial orientation. Automatic labeling of anatomical structures, subject orientation and each of the diagnostic planes is also possible. Intelligent navigation technology can operate on conventional computers, and is not dependent on specific ultrasound platforms or on the use of software to perform manual navigation of volume datasets. Diagnostic planes and VIS-Assistance videoclips can be transmitted by telemedicine so that expert consultants can evaluate the images to provide an opinion. The end result is a user-friendly, simple, fast and consistent method of obtaining sonographic images with decreased operator dependency. Intelligent navigation is one approach to improve obstetrical sonography. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives The objectives of this study were firstly to assess the longitudinal changes of various sonographic parameters of fetal head progression in relation to length of active second stage of labor, and secondly to compare ultrasound findings obtained longitudinally among fetuses with persistent occiput posterior ( OP) vs those with persistent occiput anterior ( OA) position. Methods From a series of nulliparous low-risk women at term attending the labor ward of our university hospital, transperineal ultrasound volumes were prospectively acquired at the beginning of the active second stage ( T1) and at 40-min intervals thereafter until delivery ( T2, T3). Sonographic parameters were derived from offline analysis of each volume, including the angle of progression ( AoP), progression distance ( PD), head-symphysis distance ( HSD), head direction ( HD) and midline angle. These parameters were compared between patients who delivered within 60 min from the beginning of the active second stage of labor (early delivery) and those who remained undelivered by that time (late delivery). Fetal head position was determined from stored digital images of transabdominal examinations performed at the beginning of the active second stage. Comparison was performed between fetuses with OA and those with persistent OP position at delivery. Results Spontaneous vaginal delivery was achieved in 58 (81.7%) cases, whereas vacuum extraction and Cesarean section were performed in eight (11.3%) and five (7.0%) cases, respectively. Delivery was achieved within 60 min from the beginning of the active second stage in 44 (62.0%) patients. In the early vs late delivery groups, measurements of AoP, HSD and PD at T1 were significantly different ( AoP, 143.9 ± 20.5° vs 125.3 ± 15.0°, P < 0.001; HSD, 14.8 ± 4.5 mm vs 20.9 ± 5.8 mm, P < 0.001; PD, 44.0 ± 14.1 vs 35.0 ± 13.1 mm, P = 0.008). On logistic regression analysis of data obtained at T1, maternal body mass index, oxytocin administration, neonatal birth weight and HSD appeared to predict independently duration of the active second stage. Among fetuses delivering in the OP position ( n = 10, 13.5%), Cesarean delivery was significantly more common than in those delivering in the OA position ( n = 5 (50.0%) vs n = 2 (3.1%), P = 0.001). Women with persistent OP position compared with OA showed a significantly different AoP at T1 (122 ± 17° vs 138 ± 20°, P = 0.016), HD and HSD at T1 ( HD, 112 ± 17 mm vs 86 ± 19 mm, P < 0.001; HSD, 16.5 ± 5.4 mm vs 22.8 ± 6.6 mm, P = 0.008) and at T2 ( HD, 120 ± 16 vs 82 ± 27 mm, P = 0.008; HSD, 12.6 ± 3.4 mm vs 18.5 ± 5.4 mm, P = 0.038). Conclusions AoP, PD and HSD are significantly different between patients undergoing delivery before or after 60 min from the beginning of the active second stage of labor. Ultrasound parameters are among the significant predictors of duration of the active second stage. Moreover, in fetuses persisting in the OP position vs those delivering in the OA position, fetal head progression seems to differ at early phases of the active second stage. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To assess the transvaginal ultrasonographic features of perineal masses in the lower urogenital tract in a cohort of 71 women. Methods Seventy-one women with perineal masses were referred consecutively for transvaginal ultrasonography. Two-dimensional ( 2D) ultrasound was used to scan the pelvic floor, including the urethra, vagina and rectum, and identify any possible areas of interest. A static three-dimensional ( 3D) sonographic reconstruction of the pelvic anatomy was created to further delineate the relation of the lesions with their neighboring structures. Ultrasound results were compared retrospectively with surgical pathology outcome when possible. Results Seventy-nine cystic, cystic-solid or solid masses were detected on transvaginal 2D ultrasonography in the 71 women: in 44 patients, 47 anechoic cystic masses were identified and diagnosed as vaginal wall cysts; in 19 patients, 23 hyperechoic cystic masses were diagnosed as vaginal epidermoid cysts; in each of two patients, a hypoechoic cystic-solid mass showing blood-flow signals on color Doppler imaging was diagnosed as urogenital angiomyofibroblastoma; in each of three patients, a hypoechoic cyst was diagnosed as urethral diverticulum; and in three patients with a known history of gynecological malignancy, solid heterogeneous masses with blood flow signals on color Doppler imaging were diagnosed as metastatic cancer. In all patients, 3D ultrasonography delineated the anatomical relationship of these masses to the vagina, urethra and rectum. Conclusions Transvaginal 2D and 3D ultrasonography is an accurate, non-invasive, cost-effective diagnostic modality for the delineation of congenital, septic and neoplastic lower urogenital tract perineal masses in women. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To assess the intermethod agreement between two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound methods in measuring a new index of fetal head station (the fetal head-symphysis distance (HSD)) in active labor, and to assess potential factors that may affect their agreement. Methods HSD was measured by transperineal ultrasound in 86 women in active labor, once using a 2D and once using a 3D technique. 2D images were acquired first in 43 cases and 3D images were acquired first in the other 43 women. Intermethod agreement between 2D and 3D methods was analyzed by means of intraclass correlation coefficient (ICC) and Bland-Altman analysis. In addition, potential factors affecting the intermethod reproducibility were investigated including fetal occiput position, order of acquisition, fetal head station, stage of labor, maternal body mass index and use of epidural analgesia, using the ANOVA test to check for systematic bias and Levene's test for homoscedasticity. Results Good agreement was demonstrated between 2D and 3D measurements of HSD (ICC, 0.949 (95% CI, 0.914-0.984)). No evidence of systematic difference was shown between the two methods (average difference ± SD = 0.03 ± 2.29 mm; P = 0.888). The only factor that had a significant effect on systematic difference between 2D and 3D methods was order of acquisition (P = 0.042); the first observation was higher regardless of the method used. Fetal head station had a significant effect on the homogeneity between the two methods (P = 0.004) with a better 2D-3D agreement obtained at lower head stations (SD of differences: 1.63 vs 2.59 mm). Conclusions There is very good agreement between 2D and 3D methods of assessing HSD. Agreement is better in lower fetal head stations. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To compare the variability in vascularization flow index ( VFI) seen in serial acquisitions obtained using spatiotemporal image correlation ( STIC) and using conventional static three-dimensional ( 3D) power Doppler ( PD), for both in-vitro and in-vivo models, and to evaluate whether the curves formed by VFI values obtained from successive 'frames' in a STIC dataset are consistent and resemble the waveforms obtained by spectral Doppler analysis. Methods The study was divided into two parts: in the first part (the in-vitro model) we scanned a flow phantom, while in the second part (the in-vivo model) we scanned a common carotid artery. Conventional static 3D and STIC-PD datasets were alternately acquired from these two models. VFI values were assessed from 0.38-cm3 spherical samples of the main flow region in the static 3D datasets and in every frame of the STIC datasets. The variance of the minimum, mean and maximum VFI values from each STIC dataset was compared with the variance of VFI values from the static 3D datasets. Results Ten static 3D and 10 STIC datasets were acquired from each model. Analysis of the in-vitro and in-vivo models showed a significant reduction in the variance of VFI values obtained using STIC as compared to static datasets. Additionally, we observed that the curves formed by VFI values obtained from successive frames in each STIC dataset were consistent across different datasets and that they resembled the waveforms obtained by spectral Doppler in both models. Conclusions 3D-PD indices derived from STIC are more stable than those obtained from conventional static 3D-PD datasets. The curves of VFI throughout a reconstructed cardiac cycle using STIC are repeatable and resemble those obtained by spectral Doppler analysis of the vessel. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective Several ultrasound parameters, including intrapartum transperineal ultrasound (ITU) head station, angle of progression (AOP), head-perineum distance (HPD) and head-symphysis distance (HSD), have been suggested to assess fetal head station during labor. The aim of this study was to analyze the relationship between these ultrasound parameters and to compare them with digital palpation. Methods We analyzed 106 stored volume dataset pairs that had been acquired at Stavanger University Hospital, Norway, from nulliparous women at term with prolonged first stage of labor. The volumes were acquired using a three-dimensional transducer applied between the labia majora in a mid-sagittal plane and perineally in a transverse plane. Digitally palpated head station and cervical dilatation were also noted. The results were compared using regression and correlation coefficients. Results There were good correlations between ITU head station and HPD (r=0.71), between ITU head station and HSD (r = 0.74) and between HSD and HPD (r--0.75). Palpated head station showed only moderate correlation with ITU head station (r= 0.52). Cervical dilatation showed a weak correlation with ITU head station (r = 0.30). Conclusion The ultrasound parameters showed a high degree of correlation with each other, but only moderate correlation to vaginally palpated fetal head station. [ABSTRACT FROM AUTHOR]

Objective To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery. Methods A three-dimensional transperineal ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5 and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. Results Among 71 women included in the study, 58 underwent spontaneous vaginal delivery (Group A) and 13 underwent operative delivery (Group B) (eight by .vacuum extraction and five by Cesarean section). When compared with Group B, Group A had a wider AoP only at T1 (140.0±20.2° vs 122.94-16.7°; P=O.010) and T2 (149.7±20.7° vs 126.9 ± 17.5°; P = 0.006). MLA was narrower in Group A only at T3 (21.2±11.7° vs 40.8±27.9°; P=0.043), T4 (18.2±15.0° vs 47.4±29.6°; P=0.020) and T5 (18.3±6.0° vs 34.7±4.2°; P=0.034). On stepwise forward multiple logistic regression analysis, both AoP and MLA were independently associated with operative delivery (OR = 0.955 and OR = 1.018, respectively). Conclusion Ultrasonographic assessment of fetal head descent in the second stage of labor may play a role in the prediction of the mode of delivery. [ABSTRACT FROM AUTHOR]

Objectives To assess the reproducibility of measurement of a new sonographic index of fetal head station in labor, the fetal head-symphysis distance (HSD), using three- dimensional ultrasound, and its correlation with digital assessment of fetal head descent and with the angle of progression (AoP). Methods Three-dimensional (3D) ultrasound volumes were acquired from 47 nulliparous women in active labor following assessment of fetal head station with digital examination. The HSD (the distance between the lower edge of the pubic symphysis and the nearest point of the fetal skull) was measured independently by two operators in order to evaluate intra- and interobserver reproducibility. The correlation between HSD, AoP and fetal head station was evaluated using regression analysis. Using 3D tomographic ultrasound imaging (TUI), measurements of the HSD were obtained in different parasagittal planes to evaluate the influence of inaccurate alignment of the probe with the midline of the pelvis. Results Measurement of HSD showed high intraobserver (intraclass correlation coefficient (ICC) = 0.995; 95% CI, 0.991-0.997) and interobserver (ICC= 0.991; 95% CI, 0.984-0.995) reliability. In addition, a high correlation was demonstrated between mid-sagittal and parasagittal HSD measurements. HSD showed significant negative correlation with both fetal head station and AoP. Conclusion Fetal HSD is a simple and reliable method for the assessment of fetal head descent in labor. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To quantify the intracycle variation in markers of ovarian reserve measured by antral follicle counts stratified by size using three-dimensional ( 3D) ultrasound and anti-Müllerian hormone ( AMH) in women with normal menstrual cycles. Methods Healthy volunteers with normal menstrual cycles were prospectively recruited. Three-dimensional ( 3D) ultrasound examination and blood test were performed in early ( F1) and mid-follicular ( F2) phases and in periovulatory ( PO) and luteal ( LU) phases of one menstrual cycle. Antral follicles were measured using 'sonography-based automated volume calculation' with post processing ( SonoAVC) and ovarian volume was measured using Virtual Organ Computer-aided AnaLysis ( VOCAL). Blood serum was processed for hormonal assays including AMH, follicle stimulating hormone ( FSH), luteinizing hormone ( LH) and estradiol. Repeated-measures analysis was used to examine the variance in markers of ovarian reserve in different phases of one menstrual cycle. Results A total of 36 volunteers were included in the final analysis, of whom 34 attended all four visits. Repeated-measures analysis showed a significant variation in total antral follicle count ( AFC) ( P < 0.001). However, on stratifying the antral follicles according to size using SonoAVC, a non-significant variation ( P = 0.382) was seen in small AFC (≤ 6.0 mm) and a significant variation ( P < 0.001) was seen in large AFC (> 6.0 mm). The ovarian volume showed a significant intracycle variation ( P < 0.001). A small but significant intracycle variation was noted in AMH ( P = 0.041) and a significant variation was seen in levels of serum FSH, LH and estradiol ( P < 0.05). Conclusion Small antral follicles (≤ 6.0 mm) measured using 3D ultrasound and AMH show little intracycle variation and perhaps should be evaluated when predicting ovarian reserve independent of menstrual cycle. [ABSTRACT FROM AUTHOR]

Objective To evaluate the blood FIow characteristics of the cervix in normal women and in women with cervical precancerous lesions or cervical cancer. Methods We studied 165 women with three-dimensional power Doppler ultrasound (3D-PD U), of whom 71 had cervical cancer, 61 had precancerous lesions and 33 were healthy controls. The cervix was manually traced in the stored volumes using 15° rotation steps and the following 3D-PD U indices were calculated: vascularization index (VI), FIow index (FI) and vascularization FIow index (VFI). These indices were compared among the study groups and were also correlated with features of the precancerous lesions group and cancer group. Results The three indices were all statistically significantly higher in the cervical cancer group and precancerous lesions group than in controls (P < 0.001). In addition, significantly higher values of all indices were found in the cervical cancer group than in the precancerous lesions group (P < 0.001). Further analysis according to patient characteristics in the cancer group showed that VI, FI and VFI were not significantly different in relation to grade, histology, presence of positive lymph nodes or lymphovascular space involvement (P> 0.05). However, VI was significantly higher in patients with Stages IIIB -I V cancer than in patients with less advanced disease (P = 0.045). In the cervical cancer group there was a significant positive correlation between 3D-PD U indices and cervical volume. Conclusion 3D-PD U assessment of the cervix reveals significant differences in all indices studied between women with cervical precancerous lesions or cancer and healthy women. In women with cervical cancer, an advanced stage is associated with higher VI, but 3D-PD U indices are not related to other pathological characteristics. [ABSTRACT FROM AUTHOR]

Objective To determine if anatomic primary repair with end-to-end reconstruction of the external anal sphincter (EAS) in its full length combined with separate repair of coexisting internal anal sphincter (IAS) tear, when present, results in less incontinence and better anal sphincter integrity compared with conventional primary end-to-end repair in which the IAS is not actively reconstructed. Methods Women who sustained third- or fourth-degree obstetric tears were included prospectively in the study following anatomic primary repair. Women treated with conventional primary repair prior to the study period comprised the control group. Three-dimensional endoanal ultrasonography (3D-EAUS) images were classified according to the EAUS defect score, and incontinence according to St Mark's score. Results Sixty-three women were included in the study group and 61 in the control group, with mean follow-up times of 11 and 21 months, respectively. Among women who had not delivered vaginally prior to the tear, St Mark's score ≥ 3 was reported by 9.6% (5/52) in the study group and 37.5% (15/40) in the control group at follow-up ( P = 0.002). The corresponding numbers among women who had previously delivered vaginally were 36.4% (4/11) and 42.9% (9/21), respectively (non-significant). St Mark's score correlated with the EAUS defect score ( P = 0.017). An EAS defect exceeding 50% of the sphincter length was significantly less common in the study group, and in a multivariable logistic regression model, mode of repair (anatomic vs conventional) was the only factor explaining the difference in EAS sphincter length between the two groups ( P = 0.007). Conclusion Improved continence status after anatomic primary repair was associated with a better longitudinal reconstruction of the EAS, while the integrity of the IAS did not differ between the groups. Women with a history of vaginal delivery prior to the sphincter tear had an inferior outcome regardless of mode of repair. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate the accuracy of transvaginal three-dimensional hysterosalpingo-contrast sonography using SonoVue (3D SonoVue-HyCoSy) in the assessment of Fallopian tubal patency. Methods We recruited 75 infertile patients undergoing 3D SonoVue-HyCoSy before standard diagnostic laparoscopy with chromotubation (lap and dye). Tubal patency was assessed by automated 3D coded contrast imaging (3D SonoVue-HyCoSy), and the findings were compared with the results of lap and dye. Results For detecting tubal patency among the 150 Fallopian tubes assessed, 3D SonoVue-HyCoSy had a sensitivity of 93.5%, specificity of 86.3%, positive and negative predictive values of 87.8% and 92.6%, respectively, and diagnostic accuracy of 90.0%. The test-positive rates of 3D SonoVue-HyCoSy vs lap and dye were not significantly different (82/150 vs 77/150, P > 0.05). Conclusion 3D SonoVue-HyCoSy should be considered clinically valuable as a practical, non-invasive, primary investigatory tool for evaluating tubal patency. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives Three-dimensional (3D) ultrasound is useful in the prenatal evaluation of fetal craniofacial structures, particularly as it provides a multiplanar view. However, an expert must designate the area of interest and the appropriate view, making measurement of fetal structures using 3D ultrasound both time-consuming and subjective. In this study we propose an image analysis system that measures automatically and precisely the fetal craniofacial structures and evaluate its performance in the second trimester of pregnancy using a new 3D volume analysis algorithm. Methods A universal facial surface template model containing the geometric shape information of a fetal craniofacial structure was constructed from a fetal phantom. Using the proposed image analysis system we fitted this stored template model using a model deformation approach to individual fetal 3D facial volumes from 11 mid-trimester fetuses, and extracted automatically the following standard measurements: biparietal diameter (BPD), occipitofrontal diameter (OFD), interorbital diameter (IOD), bilateral orbital diameter (BOD) and distance between vertex and nasion (VN). The same five parameters were measured manually by an expert and the results compared. Results Comparison of the algorithm-based automatic measurements with manual measurements made by an expert gave correlation coefficients of 0.99 for BPD, 0.98 for OFD, 0.80 for BOD, 0.83 for IOD and 0.99 for VN. There were no significant differences between automatic and manual measurements. Conclusion Our proposed system measures precisely the fetal craniofacial structures using 3D ultrasound, making it potentially useful for clinical service. This system could also be applied to other clinical fields in future testing. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate whether standardization of the multiplanar view (SMV) when evaluating the uterus using three-dimensional ultrasonography (3D-US) improves intra- and interobserver reliability and agreement with regard to endometrial measurement. Methods Two-dimensional (2D) and 3D-US was used to measure endometrial thickness by two observers in 30 women undergoing assisted reproduction treatment. Endometrial volume was measured with Virtual Organ Computer-aided AnaLysis (VOCAL [ABSTRACT FROM AUTHOR]

The article presents an study on the quantification of polycystic ovarian syndrome (PCOS) among Chinese women with the use of three-dimensional (3D) ultrasound and 3D power Doppler. It states that Caucasian and Chinese women with and without PCOS were examined in the study which was approved by the Clinical Research Ethics Committee of the Chinese University of Hong Kong. It concludes that Chinese women have higher stromal volume although Caucasian women are prone to hyperandrogenism.

The article presents a study which examines the level of intraobserver and interobserver agreement for both experienced and inexperienced sonologist. It notes that two scoring systems were used for ultrasonographic assessment of anal sphincter defects. Samples were taken from the datasets of all women between 20 and 40 years old who undergone a complete three-dimensional (3D) endoanal ultrasound (EAUS) in the outpatient clinic.

The article presents an analysis using two- and three-dimensional transabdominal and transvaginal ultrasound relative to lower uterine segment (LUS) thickness measurement in pregnant women with previous Cesarean section. The methodology involves 30 pregnant women wherein sonographic examinations and LUS measurements were performed. Findings show that transvaginal ultrasound was more reliable in the LUS measurements.

The article focuses on the study that assesses the role of three-dimensional (3D) power Doppler in diagnosing placenta accreta and compares its performance with gray-scale and color Doppler ultrasonography. It cites that the study was performed to 170 pregnant women and found out that 39 patients at the time of delivery are positive of placenta accrete and its variants. The study concludes that 3D power Doppler can be useful as complementary technique for placenta accrete diagnosis.

The article describes a technique for fetal volume and three-dimensional rendered ultrasound imaging that permits generation of photorealistic virtual displays. This approach permits a viewing of learning experience that is superior to watching a linear movie passively. The virtual reality (VR) protocol for fetal volume ultrasound can be applied to other anatomical regions in obstetrics and gynecological imaging or to other fields.

The article examines the correlation between anal sphincter defects and anal incontinence following obstetric sphincter tears using scoring systems for sonographic classification of defects. It aims to determine if there is a correlation between the extent of anal sphincter defects revealed by three-dimensional endoanal sonography and the degree of anal incontinence after primary repair of obstetric sphincter tears.

Objective To assess the perception of non-pregnant sonographers, sonologists and undergraduate students on the use of three-dimensional (3D) ultrasound technology in fetal medicine. Methods This was a study of two groups of non-pregnant subjects. Group I included 520 (305 female, 215 male) medical professionals who completed a questionnaire after attending a lecture on 3D imaging. Factors such as gender, career and having children were analyzed with respect to the attendee's responses about use of 3D ultrasound for medical purposes and for reassurance. Group II included 137 (75 female, 60 male, two unknown) undergraduate students from bioengineering, psychology and physiology classes who completed a questionnaire after attending a brief presentation on two-dimensional and 3D fetal imaging. Factors such as gender and area of educational interest were analyzed with respect to the students' responses about the use of 3D ultrasound for medical purposes and for parental-fetal attachment. Results In Group I, 63% said that they would like to have a 3D ultrasound examination in the future, while 14% said that they would not. Common reasons given for wanting a 3D ultrasound exam in the future were for medical purposes (3 9%) or reassurance (18%). The main differences perceived between two-dimensional (2D) and 3D ultrasound were medical advantages (65%) and parental reassurance (28%). 62.4% of Group I thought 3D technology should be in wide use in obstetric ultrasound and 73.6% thought that 3D ultrasound would reassure parents carrying normal fetuses. Gender, age and career did not have a significant influence on perception of 3D ultrasound. In Group II, the majority (91 %) said they could see a remarkable difference between 2D and 3D ultrasound. 83% responded that they would like to have a 3D ultrasound examination of their own baby in the future for the following reasons: 34% for the detailed picture, 31 % for increased abnormality detection, 13% for reassurance or curiosity; 8% thought it would be unnecessary or a negative experience. Concerning parental-fetal attachment, 72% thought 3D ultrasound would have a positive effect. The majority of Group II (93%) thought 3D ultrasound would be valuable and 56% thought 3D ultrasound would assist in diagnosing fetal abnormalities. There was no significant relationship between gender, age or area of interest and the perception of 3D ultrasound. Conclusions Responses by sonographers and physicians suggest that 3D -ultrasound will have a role in the future for medical indications and in reassuring patients carrying normal fetuses. Our results also suggest that undergraduate students believe that 3D ultrasound will be a valuable technique in obstetrics and that it will have a positive effect on parental-fetal attachment. [ABSTRACT FROM AUTHOR]

A patient with a singleton pregnancy was referred for three-dimensional ultrasonography (3DUS) at 18 + 3 weeks for suspected hypomineralization of the skull bones and absence of the nasal bones. Three-dimensional rendered images of the fetal skull revealed widening of the coronal sutures, absence of the squamous portion of the temporal bone, and absence of the occipital bone, except for two areas of ossification. In addition, a fractured right clavicle was identified. The remainder of the fetal anatomy was normal and biometry was appropriate for gestational age. Genetic amniocentesis revealed a 46,XX fetal karyotype. Family history was positive for a 5-year-old sibling with an open anterior fontanelle. Cleidocranial dysplasia was suspected. A female neonate was delivered by elective repeat Cesarean section at 40 + 3 weeks of gestation without complications and discharged home 3 days after delivery. Prenatal diagnosis was confirmed by physical and radiological evaluation. The infant died at 8 weeks of age due to respiratory syncytial virus pneumonia secondary to B-cell deficiency. RUNX2 mutations were not detected by molecular analysis. There are three relevant aspects to this case: (1) clear visualization of the widened fontanelles and hypomineralized occipital bones was possible with the use of 3DUS; (2) a clavicular fracture was identified in utero with combined high-resolution two-dimensional and 3DUS; and (3) although absence of the nasal bones is most commonly observed in fetuses with chromosomal disorders (e.g. trisomy 21 and trisomy 18), a careful examination of the skeleton should be considered in fetuses with absent nasal bones and a normal karyotype. [ABSTRACT FROM AUTHOR]

The article presents a study which detects the rate of fetal heart by four-dimensional ultrasound (4D) with spatio-temporal image correlation (STIC). It is said that STIC is a technique that allows acquisition of a fetal heart volume and visualization of cardiac structures. Furthermore, congenital heart is the leading cause of death among infants with congenital anomalies.

Objective To evaluate the accuracy and usefulness of a newly developed three-dimensional automatic bodymarker system for transvaginal ultrasonography. Methods A bodymarker system which utilizes an electromagnetic field to specify the probe position was developed. Software was written which enabled the positional information of the probe and the ultrasound image to be simultaneously displayed on a personal computer. The bodymarker was displayed as a three-dimensional graphic model. The differences between the estimated and the actual position - i.e. the error - for both position (x, y and z) and angles (azimuth, elevation and roll) of the probe were measured. The movement of the probe was then evaluated in healthy female volunteers and the comparative time required for ultrasound examination was determined. Results Both the position and the angles of the probe were accurately shown in the computer display. The errors were 1.0 mm and 0.7° (median) for position and angle, respectively. The system was also shown to work well in healthy female volunteers. Calibration of the new system required only 5.0 seconds, compared with an average of 7.6 seconds for the conventional bodymarker. Conclusion The newly developed three-dimensional automatic transvaginal bodymarker system provides an accurate indication of probe position and its tilting angle. It works well in healthy female volunteers and speeds up the examination time. It may be clinically useful for transvaginal ultrasound examination. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to evaluate the effect of two-dimensional (2DUS) compared to three-dimensional ultrasound (3DUS) imaging on the maternal- fetal bonding process. Methods Fifty mothers who had 2DUS and 50 who had 2DUS and 3DUS were included in the study. A postpartum survey by telephone interview was carried Out to assess maternal-fetal bonding. Bonding was evaluated by analysis of extent of prenatal image sharing, maternal ability to form a mental picture of the baby and mother's comments about their ultrasound images. Data were analyzed using the independent t-test, Chi-square and Mann-Whitney U-tests. Results Mothers who received 3D US showed their ultrasound images to more people (median, 27.5; interquartile range, 14.5–40.0) than mothers receiving 2D US alone (median, 11.0; interquartile range, 5.0–25.5) (P < 0.001, Z = -3.539). Eighty-two percent of the subjects screened with 3D US had a greater tendency to form a mental picture of the baby postexamination compared to 39% of the 2DUS subjects (P < 0.001, Z = -3.614). Mothers receiving a 3D US study were more likely to receive comments on the similarities/differences of the neonate compared to those having 2DUS studies. Furthermore, 70% of the mothers receiving 3DUS felt they ‘knew’ the baby immediately after birth vs. 56% of the mothers receiving 2DUS (P = 0.009, Z = -2.613). Both 2DUS and 3DUS experiences were positive, however, the comments made by the mothers undergoing 3DUS (n = 18) were more exclamatory (amazed, wonderful, fabulous) than those undergoing 2DUS (n = 4). Patients having a 3DUS examination consistently scored higher than those having a 2D US examination alone for all categories of maternal-fetal bonding. Conclusion 3DUS appears to more positively influence the perceptions of mothers to their babies postbirth compared to 2DUS. Specifically, mothers who had 3DUS showed their ultrasound images to a greater number of people compared to mothers who had 2DUS alone and this may represent mother's social support system. 3DUS may hate a greater impact on the maternal-fetal bonding process. [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility of using free-hand three-dimensional (3D) echocardiography to evaluate fetal cardiac function. Methods 3D cardiac data were collected during screening examinations for 37 normal fetuses with gestational ages of between 16 and 26 weeks. Processing of the 3D volumes included separation of the end-diastolic and end-systolic slices, segmentation of right and left ventricles, measurement of end-diastolic and end-systolic volumes, and calculation of the ejection fraction (EF) for each ventricle. In 21 fetuses at 21–24 weeks, right and left ventricle volumes and EF were compared. Results Twenty-five cases were appropriate for final statistical analysis. The volume of the ventricles increased with gestational age and estimated fetal weight. There was no significant trend in the difference between the volumes and EF of the right and left ventricles in the 21–24-week subgroup. The mean right and left ventricular EF were 54 ± 11.2% and 57.5 ± 14.6%, respectively. The mean combined EF of ventricles during gestation was 55.1 ± 10.7% and seemed to remain constant during the gestational ages studied. Conclusions 3 D echocardiography can provide estimates of ventricular volume and function and may in future be used for evaluation o f fetuses with congenital heart disease and cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the fluid volume in the pelvis immediately and 3-5 days after transvaginal ultrasound- guided oocyte aspiration (TOAS) and to identify predictive factors for intraperitoneal bleeding. Methods This was a prospective study of 83 infertile women undergoing controlled ovarian hyperstimulation followed by TOAS and embryo transfer (ET). Pelvic blood volume was measured by three-dimensional (3D) ultrasound examination 3-5 h after TOAS (post-TOAS), and prior to FT (2-3 days after TOAS; pre-ET). Pelvic blood volume was then correlated with the following procedure-related variables: day of hCG administration: number and diameter of ovarian follicles, endometrial thickness, serum estradiol levels; day of TOAS: number of retrieved oocytes, patient's perceived pain (Likert scale), duration of TOAS, diameters (using two-dimensional (2D) ultrasound) and 3D volume of pelvic fluid; day of ET: 2D diameters and 3D volume of pelvic fluid, perceived pain; pregnancy rate. Results The mean ± SD volume of blood measured by 3D ultrasound after TOAS and before ET was 12.94 ± 16.88 (range, 0-98.00) mL and 19.13 ± 17.84 (range, 0-70.20) mL, respectively. Blood volume in the pelvis correlated most strongly with number of oocytes retrieved (post- TOAS: P < 0.01; pre-ET: P < 0.05), followed by pain level (post-TOAS: P < 0.01), number of follicles (post- TOAS: P < 0.05) and endometrial thickness (post-TOAS: P < 0.05). When all study variables were held constant, the number of oocytes and serum estradiol level proved to be significant predictors of the amount of fluid in the pelvis (post-TOAS/pre-ET: P < 0.01). If 2D ultrasound was used, the best predictor of fluid volume after TOAS was the width of the fluid scanned in the pelvis (P < 0.001). Conclusions The amount of blood in the pelvis following TOAS in the present series was within acceptable clinical limits. The number of retrieved oocytes and pain after TOAS were found to be indicators of patients at risk of excessive bleeding. These findings have important implications for the improvement of postprocedural care. [ABSTRACT FROM AUTHOR]

Abstract Congenital ichthyosis, otherwise known as harlequin fetus, is a severe, generally lethal, anomaly. Prenatal diagnosis is usually possible in families at risk but requires invasive fetoscopy for skin biopsy. The application of three-dimensional ultrasound enables a greatly improved analysis of the facial morphology and thus provides an important contribution to prenatal diagnosis. Although such three-dimensional diagnostic procedures are performed in specialized centers, sonographers should be aware of the signs observed at routine two-dimensional ultrasound examination in order to ensure appropriate referral for diagnosis. We describe two consecutive pregnancies of the same parents in which two- and three-dimensional ultrasound were used in the prenatal diagnosis of harlequin fetus. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of this study was to perform three-dimensional ultrasound volumetry of intrauterine contents in cases of normal and failed pregnancies and correlate these with conventional two-dimensional measurements. Methods This was a cross-sectional observational study. Three-dimensional volumetric data were collected from a total of 111 patients with first-trimester singleton pregnancies together with conventional two-dimensional measurements. A single investigator performed all ultrasound scans and volume measurements. Results Among 111 participants, 30 had an ongoing pregnancy and 81 had a miscarriage (anembryonic pregnancy 30, missed miscarriage 30, and incomplete miscarriage 21). There were no significant differences in age, parity, or gestational age between groups. A positive linear correlation was demonstrable between the crown–rump length and gestational sac volume in normal pregnancies (r = 0.962) and between gestational sac volume and gestational age, but the correlation was weaker in cases of missed miscarriage (r = 0.561). The volume of the retained products of conception as measured by three-dimensional ultrasound volumetry in cases of incomplete miscarriage also showed a strong linear correlation (r = 0.938) to their maximum anterior–posterior diameter. There was an exponential correlation between the mean gestational sac diameter and gestational sac volume and the crown–rump length and embryonic volume in cases of both normal and failed pregnancies. The mean gestational sac diameter:crown–rump length ratio (P = 0.008) and gestational sac volume:embryonic volume ratio (P = 0.023) in missed miscarriages were significantly higher than those in ongoing pregnancies. Conclusion Three-dimensional ultrasound volumetry of intrauterine contents in normal and failed pregnancies correlates well with conventional two-dimensional measurements. Volumetric assessment does not seem to improve the diagnosis of... [ABSTRACT FROM AUTHOR]

Abstract Objectives To compare transvaginal and transrectal three-dimensional ultrasound in determining the morphology and measurements of the female urethra. Design Sixty-five women who had not had surgery for incontinence or pelvic floor descent had transvaginal and transrectal sonography using a 7.5-MHz mechanical sector endoprobe with three-dimensional facilities. The multiplanar display of the scanned volumes allowed detailed morphologic assessment of the urethra and the measurement of distances and volumes. Statistical endpoints were: sagittal urethral diameter, maximum rhabdosphincter length and thickness, maximum thickness of the smooth muscle complex, and the volumes of the rhabdosphincter and the smooth muscle complex. Values were compared between the two approaches using Student’s t-test and Bland–Altman analysis. Results Both vaginal and rectal scans were feasible. However, significant differences between the two approaches were found for the sagittal diameter of the urethra (8.4 ± 1.9 mm on vaginal vs. 11.5 ± 2.2 mm on rectal scans, P < 0.01) and the transverse diameter of the urethra’s smooth muscle complex (11.2 ± 0.3 mm on vaginal vs. 8.6 ± 0.2 mm on rectal scans, P < 0.001). No other variables showed significant differences. Compression of the urethra and displacement under the symphysis pubis were observed when the ultrasound probe was applied vaginally. Bland–Altman analysis showed acceptable variability for differences of distances but considerable variability for the differences of volumes. Conclusion The female urethra can be examined both vaginally and rectally by three-dimensional ultrasound. A transvaginally applied probe seems to have a compression effect on the urethra. [ABSTRACT FROM AUTHOR]

Purpose To assess particular features of fetal hand evaluation using three-dimensional ultrasound, and to determine whether any advantage is offered by three-dimensional over two-dimensional ultrasound in fetal hand evaluation. Methods Three-dimensional fetal data were collected prospectively from 44 hands in 40 fetuses from a predominantly high-risk patient population. All had a concurrent two-dimensional ultrasound examination of the hands. Diagnoses from two- and three-dimensional ultrasound examinations were compared and additional information from the three-dimensional volume assessment was noted. Three-dimensional assessment of distal forearm bones, wrist position, finger configuration and number of metacarpals and digits was recorded. Results Hands were appropriately identified as normal (32/32) or abnormal (12/12) by both two- and three-dimensional ultrasound. Three-dimensional ultrasound provided additional information when compared to two-dimensional ultrasound in both normal and abnormal hands, including the provision of three orthogonal planes with one volume acquisition, allowing rotation of the volume so that hands could be evaluated in planes not possible during two-dimensional imaging, assessment of a hand with loosely curled fingers as normal, the ability to evaluate thumb and fingers simultaneously, and improved assessment of abnormal hands. Conclusions Three-dimensional ultrasound offers the potential to provide greater information in fetal hand evaluation for both normal and abnormal hands. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To compare first-trimester placental volume in chromosomally abnormal and normal pregnancies. Methods Placental volumes were routinely recorded at the time of nuchal translucency thickness measurement at 10–13 weeks of gestation. This was done using customized three-dimensional ultrasound equipment and measurements were then converted to the placental quotient (placental volume/fetal crown–rump length). The possible difference in placental quotient between chromosomally normal and abnormal pregnancies was examined. Results A total of 2863 pregnancies was evaluated, including 17 with major chromosomal defects (nine cases of trisomy 21, four of trisomy 18, two of trisomy 13, and one each of Turner syndrome and 48,XXY + 21). The median placental quotient in the chromosomally abnormal group (0.67) was significantly lower than that in the normal fetuses (0.98). In nine of the 17 affected pregnancies the quotient was below the 10th centile of the normal range. Conclusions Assessment of placental volume may prove to be useful in first-trimester risk assessment for chromosomal anomalies. [ABSTRACT FROM AUTHOR]