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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]

Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers. [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]

Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e.g. mesoblastic nephroma) and of the retroperitoneum, such as teratoma. The information derived from bp-MRI, and concerned with water motions in different tissues, improved the morphologic details provided by conventional foetal MRI. It has the potential to increase the value of MRI in the assessment of a wide range of foetal pathologies, particularly in renal diseases, allowing an adequate management decision and therapy. [ABSTRACT FROM AUTHOR]

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]

Growing numbers of pregnant women across the world now routinely have ultrasound scans as part of antenatal care, including in low-income countries. This article presents the findings of anthropological research on the use of obstetric ultrasonography in routine antenatal care in Hanoi, Viet Nam. The findings come from observation, a survey and interviews with women seeking ultrasound scans at a main maternity hospital and interviews with doctors providing ultrasound there. We found a dramatic overuse of ultrasound scanning; the 400 women surveyed had had an average of 6.6 scans and 8.3 antenatal visits during pregnancy, while one-fifth had had ten scans or more. Doctors considered obstetric ultrasound an indispensable part of modern antenatal care. For two-thirds of the women, the main reason for frequent scans was reassurance of normal fetal development. However, the women often also said their doctor had recommended the scans. This overuse must be seen in the context of growing commercialisation in the Vietnamese health care system, where ultrasound provides an important source of revenue for both private and public providers. There is an urgent need in Viet Nam for policy and practice guidelines on the appropriate use of ultrasonography in pregnancy and how best to combine it with essential antenatal care, and information dissemination to women. De plus en plus de femmes enceintes se soumettent systématiquement à des échographies dans le cadre des soins prénatals, même dans les pays à faible revenu. Cet article présente les conclusions d'une recherche anthropologique sur l'utilisation des échographies pour la surveillance de la grossesse à Hanoi, Viet Nam. Il utilise des observations, une enquête, et des entretiens avec des femmes venues pour une échographie dans une grande maternité et avec des médecins réalisant les échographies dans cet hôpital. Nous avons constaté un recours excessif aux échographies ; les 400 femmes interrogées avaient subi en moyenne 6,6 échographies et 8,3 visites prénatales pendant leur grossesse, alors qu'un cinquième avaient eu dix échographies ou plus. Les médecins considéraient les échographies comme un élément indispensable e soins prénatals modernes. Pour les deux tiers des femmes, la principale raison de la fréquence des échographies était de s'assurer du développement normal du fłtus. Néanmoins, les femmes ont aussi fréquemment affirmé que leur médecin avait recommandé ces examens. Cet emploi excessif doit être placé dans le contexte de la commercialisation croissante du système de santé vietnamien, où les échographies constituent une source appréciable de revenu pour les praticiens privés et publics. Le Viet Nam doit sans tarder définir des directives pratiques sur l'utilisation correcte des échographies obstétriques et sur la meilleure manière de les associer avec des soins prénatals essentiels, et diffuser des informations aux femmes. A nivel mundial, cada vez más mujeres embarazadas solicitan que se les practique una ecografía rutinaria como parte de la atención antenatal, incluso en los países de bajos ingresos. En este artículo se exponen los hallazgos de investigaciones antropológicas sobre el uso de la ecografía obstétrica en la atención antenatal rutinaria en Hanoi, Viet Nam. Los hallazgos provienen de observaciones, una encuesta y entrevistas con mujeres que buscan exámenes de ecografía con médicos de un importante hospital de maternidad. Se encontró un uso excesivo de la ecografía; las 400 mujeres encuestadas habían tenido un promedio de 6.6 ecografías y 8.3 consultas antenatales durante el embarazo, mientras que una quinta parte había tenido diez o más ecografías. Los médicos consideran a la ecografía obstétrica una parte indispensable de la atención antenatal moderna. Para dos terceras partes de las mujeres, el motivo principal para tener ecografías frecuentes era que les aseguraran un desarrollo fetal normal. Sin embargo, ellas a menudo dijeron que su médico había recomendado las ecografías. Este uso excesivo debe verse en el contexto de una creciente comercialización en el sistema de salud vietnamita, donde la ecografía constituye una fuente importante de ingreso tanto para los prestadores de servicios privados comos públicos. Existe una necesidad urgente en Viet Nam de formular normas de políticas y prácticas sobre el uso adecuado de la ecografía en el embarazo y sobre la mejor forma de combinarlo con la atención antenatal esencial, y de difundir la información a las mujeres. [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]

Ultrasound is the most valuable imaging modality in evaluating the female presenting with pelvic infection The appropriate interpretation of the ultrasound study requires correlation with the patient's clinical history and laboratory values. Pelvic sonography is commonly performed in patients with a clinical diagnosis of pelvic inflammatory disease. Sonography can also help to distinguish acute from chronic abnormalities in the fallopian tubes. Though the study may be normal or sometimes non-specific, there are a variety of findings that are characteristic of this process. Understanding of the sonographic features of pelvic inflammation, salpingitis, pyosalpinx, tubo-ovarian complex and tubo-ovarian abscess will allow the interpreter to make more specific, clinically useful diagnoses. [ABSTRACT FROM AUTHOR]

The spinal cord is an important part of the central nervous system as well as the brain. The vertebral structure develops remarkably early during embryonal and fetal periods. As the cranium develops from early pregnancy with ossification and gradual closure of the fontanelles and sutures, the vertebral bony structure is also formed with ossification and gradual closure of the neural arches during the fetal period. Open spina bifida, which results from a failure of neural arch closure, has been demonstrated by ultrasound and magnetic resonance imaging in utero . Postnatal neurological deficit is greatly dependent on the lesion level of spina bifida and the condition of the exposed spinal cord. Therefore, accurate detection of the lesion level and spinal cord appearance before birth has an important role in predicting neurological prognosis. Because it is hard to demonstrate fetal bony structure including vertebral arches and ribs on a single image by two-dimensional (2D) ultrasound, precise diagnosis of spinal lesion is difficult for examiners. Several reports have been published on two-dimensional detection of the spinal lesion level. After introduction of three-dimensional (3D) ultrasound technology in the field of fetal neuroimaging diagnosis, however, more accurate, objective and comprehensive information has been added on fetal vertebra/spine development and spine lesion such as open spina bifida even in the first and early second trimesters. Multiplanar image analysis and rendering of bony structure by 3D ultrasound technology have contributed greatly to the precise demonstration of normal/abnormal vertebra and spinal cord. Exact and objective diagnosis of spina bifida during pregnancy leads to the prediction of postnatal neurological deficit and to proper management. [ABSTRACT FROM AUTHOR]

Human placental circulation in the first trimester of pregnancy remains a subject of scientific debate. Most of the acquired knowledge on the physiological background of maternal-fetal interface relies on old studies, most of them performed in non-hemochorial placentas and using light and electron microscopy for the pathological specimens' evaluation. Recently, some ultrasonographic research in this field, using pulsed-wave and/or colour Doppler, yielded contradictory results. The availability of these non-invasive methods should allow the in vivo investigation of placental circulation since early phases of human pregnancy. A more recent technique – Power Doppler – should be preferred considering its resolution, angle-independence, higher sensitivity for lower velocities and absence of known harmful bioeffects in the early periods of gestation. We provide an overview on first trimester maternal-fetal circulation, assessed by non-invasive techniques, namely by transvaginal power Doppler ultrasonography, trying to contribute to a better understanding of the anatomo-physiological aspects of human placental circulation. [ABSTRACT FROM AUTHOR]

The advantages of high resolution ultrasonography are that it allows more precise diagnosis of any abnormalities in early pregnancy. The frequency of spontaneous interruptions of the development of the reproductive process is very high, especially during the initial stages. It is calculated that, considering the shortcoming of the fecundation, of each 100 potential pregnancies, only 31 will reach full term with a live fetus. The frequency of abortion, considering this as the spontaneous interruption of a pregnancy before the fetus has reached viability, depends therefore on the approach that we use to define that pregnancy exists. [ABSTRACT FROM AUTHOR]

The recent advance of three-dimensional/four-dimensional ultrasound has clearly demonstrated details of fetal movement. Many musculoskeletal tissues and their innervation are associated with hand/finger positions and movements. This article focuses on details of fetal hand/finger positioning and movement in early pregnancy in vivo. From our data, mild adduction of the thumb and atonic fingers were observed from 11 weeks of gestation and the appearance of the palm was clearly different from that at 9 and 10 weeks. Fetuses start to clench and unclench their fists from 12 weeks and independent movement of each finger is occasionally seen from 13 or 14 weeks. In our series of fetuses with congenital central nervous system diseases, fetuses had normal hand/finger positioning and movements. We present two cases with congenital hand/finger malpositioning - one had an overlapping finger which was conspicuous after 13 weeks; the other had contractural malpositioning of the wrist demonstrated from 11 weeks. There may be different mechanisms associated with muscular and tendon variation between abnormal palmar/wrist flexion and abnormal digital flexion. Three- and four-dimensional ultrasound may reveal further details of fetal behaviors in utero. [ABSTRACT FROM AUTHOR]

One of the central issues in developmental neurology is the need to formulate concepts helping to understand human behavior, which reflects the central nervous system from early intrauterine age to the young infant and even up to adulthood. Real-time ultrasound observations have been used from the early 1980s onwards to witness the origin, occurrence and developmental course of specific fetal movement patterns emerging during early prenatal life. A large variety of movement patterns has been observed: startles; general movements; breathing movements; head, trunk and extremity movements; jaw openings; yawning; sucking; swallowing; hiccups; and hand/face contacts. In combination with fetal heart rate monitoring, two-dimensional ultrasound has been used in the third trimester to document the development of fetal behavioral states continuing from pre- to postnatal life. In the early 1990s we started to perform longitudinal examinations in twin pregnancies observing similar movement patterns to those in singletons. In multiple pregnancies, the inter-twin variance of different subsets and the possible impact of internal and external parameters can be studied. In addition, we have studied inter-twin reactions towards touch, reflecting the development of both initiative and sensitivity towards touch and finally the first inter-human contacts. Here we describe some essential issues of the documentation of fetal behavior in singleton and twin pregnancy. [ABSTRACT FROM AUTHOR]

Rapid improvements in the capacity of data processing due to technological breakthroughs in processor engineering is the basis of spatial imaging. Spatial imaging is the main benefit of three-dimensional sonography and it is used for visualization of fetal anatomy in three dimensions. Modern machines are capable of performing spatial imaging in near real time, called four-dimensional sonography. Four dimensional sonography in multifetal pregnancies can be used for detection and evaluation of intertwin contacts, because it allows simultaneous visualization of both fetuses and assessment of their motor activity. The main benefits of four-dimensional sonography include: accurate recognition of an isolated motor activity of a single fetus; distinguishing between spontaneous and stimulated motor activity; and spatial visualization of the intertwin area. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if measurement of the abdominal subcutaneous fat antenatally using ultrasound is comparable to other established indices of fetal growth restriction (FGR). One hundred women with singleton pregnancies had an ultrasound scan within 1 week of delivery at term. Ultrasound measurements included abdominal circumference (AC), liquor assessment by amniotic fluid index (AFI) and abdominal subcutaneous fat thickness (FAB). After delivery, infants were weighed and skinfold thickness at triceps and subscapular sites measured. Ponderal index was also calculated. Infants with an abdominal subcutaneous fat measurement antenatally of 5 mm or less (n = 41) were more likely than those with a fat measurement of more than 5 mm (n = 59) to have an AFI < 8 cm (P < 0·001) and to have an AC < 10th centile (P < 0·001). Decreased antenatal fat thickness was associated postnatally with a lower mean ponderal index (24·2 kg/m[sup 3] vs. 25·5 kg/m[sup 3], P < 0·02) and a decreased skinfold thickness (4·84 vs. 5·55 mm, P < 0·003 and 3·88 vs. 4·37, P < 0·03 for triceps and subscapular, respectively). This study shows that fetal abdominal subcutaneous fat measurement correlates with established predictors of fetal nutrition such as liquor volume, abdominal circumference, ponderal index, triceps and subscapular skinfold thickness. [ABSTRACT FROM AUTHOR]

The aim of the study is to demonstrate the ability of abnormal Doppler indices to predict the acid-base status of the fetus. A pulsed Doppler study of umbilical artery, middle cerebral artery and thoracic aorta were assessed on 30 intrauterine growth restricted and 27 appropriate-for-gestational-age fetuses immediately before cordocentesis. All the fetuses with absent end diastolic velocity in the umbilical artery were found to be acidemic by cordocentesis. Thoracic aorta pulsatility index (PI) increased and middle cerebral artery PI decreased significantly with increased umbilical impedance (r = 0·702, r = -0·340, respectively). Umbilical artery and thoracic aorta PI significantly increased, whereas middle cerebral artery PI decreased with a decrease in umbilical blood pH (r = -0·760, r = -0·642, r = 0·292, respectively). Doppler findings have a very strong correlation with the acid-base status of the fetuses. Increased umbilical impedance is associated with progressive impairment of placental gas exchange and that by the time diastolic flow is lost hypoxaemia or acidaemia is usually present. [ABSTRACT FROM AUTHOR]

A total of 2741 high-risk pregnant mothers underwent invasive prenatal procedures, and in 94 of them (3·4%), fetal chromosomal or genetic anomalies were detected. In this study, we report on single pericentric inversions of chromosome 9 as well as translocations, which constituted 32% (30 of 94) and 16% (15 of 94) of all identified chromosomal or genetic abnormalities, respectively. In six fetuses of the 30 with an inversion of chromosome 9, ultrasound findings were abnormal and consisted of hydramnios, anhydramnios, hydroureter, hydronephrosis, encephalocele and prune belly syndrome, occurring singly or in combination. Among the 15 fetuses with chromosomal translocations, five had sonographic abnormalities. In conclusion, we found detailed ultrasound survey of fetuses with either translocations or inversions of chromosome 9 to be an additional source of useful information concerning fetal status that could be of value in genetic counselling of affected parents. [ABSTRACT FROM AUTHOR]

The use of therapeutic ultrasound by physical therapists on pregnant women is currently contraindicated due to unknown effects it may have on the developing fetus. This study examines the effects of therapeutic ultrasound (US) on the development of fetal mouse limbs in an in vitro organ culture system by placing mouse limbs (N 241) in a culture and exposing them to daily US treatments lasting 5 minutes for 4 days at a frequency of 3 MHz and one of the following intensities (SATP) : 1.0 W/cm2 and 100% duty cycle (CONT) , 1.0 W/cm2 (1.0 PULSED) or 0.1 W/cm2 (0.1 PULSED) at 20% duty cycle, and sham controls (SHAM) . Limbs were examined histologically and serial cross sections were rated by blinded observers using a predetermined criteria for relative limb development. The percentage of nonviable limbs was elevated in limbs treated with 1.0 PULSED ultrasound and was two times higher after treatments with CONT ultrasound. Quantitative analysis of collagen distribution was performed using computerized image analysis of Sirius Red/Fast Green stain. Collagen distribution within the dermis and bone of fetal limbs was significantly increased by the lowest dose of pulsed US (0.1 PULSED) and tended to be attenuated by treatment using higher intensities of US (p < 0:05) . A signifi cant elevation in histological scores of limb development was produced in both the bone and dermis by 1.0 PULSED US and in the bone region following CONT US administration. Both pulsed and continuous US treatment can cause signifi cant changes in the histological appearance and collagen distribution of day 14 and day 18 fetal mouse limbs when treated in vitro. [ABSTRACT FROM AUTHOR]

Presents topics of studies published in the February 1999 issue of the periodical 'Journal of Obstetrics and Gyneacology,'. Desirability of informed choice for ultrasound screening; Alteration of the IGF-1 receptor in the microvillous membrane of the placenta in fetal growth restriction; Persistence of the right umbilical vein in a case of suspected Noonan's syndrome.

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]

New generation technologies provide alternative ways of assessing the female pelvis, and provide improved estimates of the incidence of uterine leiomyoma. To determine the incidence of uterine leiomyoma and other incidental findings, the request forms for pelvic ultrasound scan and the scan results of 2,034 consecutive women was reviewed. There were 586 women with scan-detected uterine leiomyoma giving an incidence of 29.9%, although only 3% of the women had clinically suspected leiomyoma. Pain was the leading indication for a pelvic ultrasound scan in women without a uterus, whereas in women with a uterus, bleeding was the leading indication. Other scan findings included ovarian cyst, 11.4% and polycystic ovaries, 7.5%. Uterine leiomyoma was four times more frequent in women over 40 years (odds ratio 4.1, 95% confidence interval, 3.3-5.0). These women were two times more likely to have multiple leiomyomas (OR 2.01, 95% CI, 1.4-2.8) and 30% more likely to have large leiomyomas (OR 1.3, 95% CI, 1.0-2.1). [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]

This was a retrospective study of 140 women attending a termination clinic from 1 April 2002 to 31 March 2003. All women had a transvaginal ultrasound scan. Of 140 women, 56 women benefited from the scan; 26.7% had non-viable pregnancy, 35.71% did not remember their LMP, 12.5% had discrepancy between the scan and LMP. Incidental findings were noted in 24.6% of which two had a twin gestation, nine had ovarian cysts, one had an ectopic pregnancy, one had a hydatidiform mole, one conceived with an IUCD and one had a bicornuate uterus with pregnancy in one horn. Two of the nine women with ovarian cysts needed a laparotomy. This study concludes that routine transvaginal scan (TVS) scan is an essential investigation for proper assessment of all women requesting termination of pregnancy. TVS is a safe and effective procedure which provides useful information regarding gestational age, viability of pregnancy and uncertain dates. In cases of the ectopic pregnancy and the hydatidiform mole transvaginal ultrasound helped us in appropriate management from the outset and minimised complications. [ABSTRACT FROM AUTHOR]

Editorial. Addresses safety issues related to the use of ultrasound in pregnancy. Research on the biological effects of ultrasound; Guidelines for using ultrasound in pregnancy.

This is a prospective study comparing the performance of transvaginal ultrasound scan with laparoscopy as the last diagnostic tool in a clinically suspected ectopic pregnancy. Both diagnostic methods have the same sensitivity of 100%. Transvaginal ultrasound scan had a specificity of 73·7% and a positive predictive value of 89·8%. Laparoscopy had a specificity of 84·8% and a positive predictive value of 94·6%. The use of laparoscopy could avoid laparotomy in only 3·4% of patients. Since transvaginal ultrasound scan is easier, safer and cheaper than laparoscopy, more emphasis should be laid on its use in our environment than laparoscopy. [ABSTRACT FROM AUTHOR]

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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]

The study objective was to investigate whether ultrasound (US) monitoring is essential during treatment with clomiphene citrate (CC) for ovulation induction, as recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) and the National Institute for Clinical Excellence (NICE). We performed a systematic review of all studies investigating the effects of US in the treatment of ovulatory dysfunction with CC. The main objective of this review was to investigate whether US monitoring during CC treatment reduced multiple pregnancy rates. There was insufficient evidence to suggest that US monitoring reduces multiple pregnancy rates or improves pregnancy rates. On the other hand, no indication that treatment with CC is safe without US monitoring was identified. The small number of relevant studies and the heterogeneity observed in the methodologies of each study prohibit reliable conclusions to be drawn. There is currently no basis for amending the evidence base (good-practice points) used in the RCOG and NICE guidelines, which recommend the use of US to monitor the ovaries during stimulation with CC. [ABSTRACT FROM AUTHOR]

The majority of triplet and higher order multiple pregnancies now result from ovulation induction/superovulation rather than in vitro fertilisation. However, clomiphene citrate is still widely prescribed by gynaecologists and general practitioners who do not have access to ultrasound monitoring. The objective of our study was to determine the prevalence of multifollicular development with different doses of clomiphene citrate. A retrospective review of transvaginal ultrasound monitoring of 425 cycles in 182 women receiving clomiphene citrate from January 2002 to December 2003, was studied. Three or more follicles of ≥ 14 mm were identified in 58 cycles (14%). Patients received 50 mg of clomiphene citrate in 52 of these 58 cycles and 25 mg in the remaining six. One patient was noted to have developed five follicles and 10 patients developed four follicles. One patient developed six follicles, despite receiving only 25 mg clomiphene citrate daily. It was concluded that a significant number of women (14%) developed three or more follicles, despite receiving low doses of clomiphene citrate. [ABSTRACT FROM AUTHOR]

Our aim was to test the use of single serum progesterone measurement together with βhCG in the management of women with pregnancy of unknown location. This was a retrospective study of 126 patients presenting with a clinical picture suggestive of ectopic pregnancy, when ultrasound examination was inconclusive. All the patients had serum progesterone level measured by radioimmunoassay in conjunction with βhCG. The study showed that a protocol combining single serum progesterone measurement and βhCG is helpful in managing women with suspected ectopic pregnancies, when the ultrasound examination is inconclusive. High levels of progesterone are reassuring as regards ongoing viable pregnancies and low levels allow a definitive differentiation between viable and non-viable pregnancies. However, low progesterone could not efficiently differentiate between miscarriage and ectopic pregnancy. The use of βhCG levels in conjunction with serum progesterone is helpful, particularly with serum progesterone levels between 16-80 nmol/l. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine prospectively the change in results of bone ultrasonometry measurement during pregnancy in healthy German women. Study design Quantitative ultrasonometry (QUS) of the phalanges was performed in 60 healthy, pregnant women. Measurements of amplitude-dependent bone propagation velocity (speed of sound; AdSOS) and the bone transmission time (BTT) were performed during the three trimesters of pregnancy in 60 patients. Results: During pregnancy, a significant increase in body weight and body mass index (p < or = 0.001) were observed. In accordance with bone ultrasonometry, a significant reduction in AdSOS was found in each trimester; AdSOS was significantly lower in the second and third trimesters compared with the first (p < or = 0.001). The BTT values also decreased significantly in the second and third trimesters compared with the first (p < or = 0.001). No significant influence was found of possible risk factors such as family risk of osteoporosis, previous pregnancies, age at menarche and prior use of oral contraceptives on QUS measurement results. Conclusions: During normal pregnancy, we found a significant reduction of quantitative ultrasonometry variables AdSOS and BTT in healthy pregnant women. This decrease had a large influence on the t score and Z score of QUS in our study and demonstrates therefore a possible clinical relevance. The decrease was independent of osteoporosis-related risk factors and the increase in body weight. More large-scale, prospective studies are needed to increase our knowledge about the mechanism of bone turnover during pregnancy and lactation. [ABSTRACT FROM AUTHOR]

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 determine the factors affecting the pregnancies with intrauterine devices. Design and Methods: The intrauterine device (IUD) locations in pregnancies with IUDs referring to SSK Aegean Maternity Hospital were determined by ultrasonography (USG) in a 6 year period. Three hundred and eighteen pregnancy cases (pregnancy group) were observed together with intrauterine devices. All intervally applied IUDs were CeT380A. All demographic characteristics of the cases together with determination of IUD localizations were recorded, and these cases were compared with 300 cases (control group) using CuT380A and under routine follow-up in our clinic. Results: Ultrasonographic examination revealed IUD dislocation in 64% of 318 cases, whereas only 11% of the control group had dislocated IUDs. The difference between two groups was statistically significant. Especially in cases where the pregnancy group was less than 20 years old, IUD dislocations were recorded in 87.5%. The statistical analysis revealed a significant correlation in the distribution of IUD pregnancies according to years. When the demographic characteristics of two groups were compared, no statistically significant correlation was observed between the demographic characteristics and pregnancies with IUDs. There were 89 cases (27.9%) who decided on the continuation of IUD pregnancies. Unfortunately, 40% of these cases resulted in abortion. Only in 27% of 56 cases after IUD extraction because of IUD dislocation was miscarriage recorded. Meanwhile, 77% of the 26 cases with IUD left in the uterine cavity presented with miscarriage. Of the total of 36 miscarriages, 33% were =6 weeks pregnancy, and 27% were over 10 weeks. Conclusion: IUD dislocation is a significant factor affecting IUD pregnancies. The fact that dislocation is most common in the first year reveals the necessity for more frequent controls in this period. [ABSTRACT FROM AUTHOR]

The capacity of four-dimensional sonography to evaluate complex facial expressions allows recognition of a common behavior, yawning. Although there has been remarkably little interest in yawning in research and medical practice, even though it is an everyday phenomenon, we submit an original interpretation on the basis of knowledge derived from phylogeny and ontogeny. As a flip-flop switch, the reciprocal interactions between sleep- and wake-promoting brain regions allow the emergence of distinct stares of arousal. By its ontogenical links with REM sleep, yawning appears as a behavior which procures an arousal reinforcement through the powerful stretch and the neuromuscular rewiring induced. Yawning indicates a harmonious progress in the development of both the brainstem and the peripheral neuromuscular function, testifying to the induction of an ultradian rhythm of vigilance. The lack of fetal yawn, frequently associated with lack of swallowing, associated or not with retrognathia, may be a key to predict a brainstem's dysfunction after birth. [ABSTRACT FROM AUTHOR]

Transvaginal sonography is indispensable for monitoring of follicular growth and is used for aspirating the follicular fluid for oocyte retrieval. Its use has improved the accuracy of embryo replacement into the uterus, or via the uterus, into the Fallopian tube and guidance of Fallopian-tube catheterization. Other ultrasonically guided procedures analyzed in this review article are aspiration of the ovarian cysts, drainage of cul-de-sac abscesses and selective reduction of multiple pregnancies. The advantages of ultrasonically guided transvaginal procedures are their performance under real-time imaging, relative simplicity, and low procedure-related complication rate. Most of these procedures can be performed in an office or emergency-room setting, but some require carefully monitored hospital protocols. [ABSTRACT FROM AUTHOR]

The article discusses the ultrasound evaluation of multifetal gestation. It notes that ultrasound has the potential to decrease perinatal morbidity and mortality in multiple gestation pregnancies and can be beneficial in assessing a range of potential fetal complications. Also discussed are the embryology and clinical characteristics of multifetal gestations, the determination of amnionicity and chorionicity in a multifetal pregnancy, amniotic fluid volume assessment, and fetal growth.

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]

The development of the central nervous system (CNS) is traced through four overlapping processes: neurogenesis, migration, synaptogenesis and myelination. The complexity of CNS development reflects the complexity of sensomotor, cognitive, affective and behavioral development. One of the methods reflecting successful development of the CNS is investigation of behavioral patterns pre- and postnatally. After the immobile phase, the first fetal movements appear at 7.5-8 weeks with spontaneous trunk and limb vermicular movements. After several days general movements (GM) and startles appear, involving the trunk, head and limbs, with an expanding motor repertoire with increasing gestational age from 10 weeks onward. It has been shown that the repertoire of fetal movements consists exclusively of motor patterns that can also be observed postnatally, and that there is a high degree of continuity of neural functions before and after birth. However, the newborn's behavioral repertoire expands rapidly with patterns never observed in the fetus, such as the Moro response. Specific fetal movement patterns called GM are maintained for several weeks postnatally. Afterwards, this fetal movement pattern disappears and is replaced by a qualitatively different, transient 'fidgety' movement pattern. The question of how fetal or neonatal behavior should be assessed raises an essential point in fetal and neonatal studies: the distinction between 'quantity' and 'quality' of motor patterns. Lack of fluency and existence of considerable variation and complexity are the main characteristics of abnormal GM. Four-dimensional (4D) ultrasound as a new diagnostic tool offers a practical means for assessment of neurological development, as well as for detection of anatomical pathology. The first reports have proved that 4D sonography can assist in the better understanding of both somatic and motor development of the fetus. Videotaping according to Prechtl's methodology is the best for the assessment of neonatal behavior. According to our research, there is good correlation of behavioral patterns from the late fetal and early neonatal period. Continuing research on behavior from the fetal to the neonatal period is a promising activity, with the potential for early detection of neurological impairment and better understanding of the etiopathogenesis of cerebral palsy. [ABSTRACT FROM AUTHOR]

Fetal behaviors gradually integrate into more complex movements in relation to each other along with functional central nervous system development. Investigating the ontogenesis of fetal behavior made it possible to allow prenatal localization of functional brain impairment, however, it is still difficult to deduce higher brain function in human fetuses. Fetal learning has the potential to be a new parameter to deduce higher brain function in the human fetus. We investigated fetal learning from a behavioral development perspective assessed by a conventional parameter, i.e. eye movement patterns. After at least 32 weeks of gestation, the fetuses presented habituation to vibro-accoustic stimulation. Fetuses less developed required significantly more trials to show habituation than developed fetuses from a behavioral standpoint even at the same gestational age. Three- or four-dimensional ultrasound evaluation also provides new findings in fetal behaviors in early gestation. These methods could be new parameters to assess fetal brain function, however, it is necessary to choose appropriate parameters and to develop easy and ubiquitous criteria, which cover higher brain function throughout the entire gestational stage. [ABSTRACT FROM AUTHOR]

To study the utility of fetal heart rate (FHR) monitoring and actocardiogram for fetal diagnosis and the classification of fetal behavioral states, a comparison of the techniques and their results is undertaken. FHR analysis is straightforwardly applied in the criteria for fetal behavioral states, which are classified by FHR and movements of the fetal body, extremities and eyes, and obtained by one cardiotocogram and two real-time scanners. The actocardiogram records both FHR and fetal movement signals, where fetal gross movements, breathing and hiccuping are revealed but no eye movement. It is useful in the exclusion of a false-positive, non-reactive non-stress test, physiological sinusoidal FHR and false perception of hiccuping, and also detects fetal movement or its loss in pathologic cases. Fetal behavioral states 1F, 2F and 4F are recognized by the actocardiogram alone, but 3F is not identified unless eye movement is detected. It is simpler to classify all behavioral states by the actocardiogram and one real-time scanner than by the original technique. The actocardiogram alone, however, can identify 3F, if quantitative values of variability and acceleration are provided in 1F and 3F. Simple actocardiographic active and resting fetal states are useful not only to exclude false FHR diagnosis, but also to study complete fetal functional development at 37 weeks or more of gestation. Computer processing of electrical signals makes it possible to analyze cross-correlation of FHR and fetal movement, and automatically to detect fetal active and resting states, fetal breathing and hiccuping. It is concluded that the actocardiogram is studied by simpler parameters than the multiple ones of fetal behavioral states, and is useful for the analyses of FHR and fetal behavior. [ABSTRACT FROM AUTHOR]

During recent decades, the development of ultrasonic techniques has enabled the direct visualization of fetal life in utero. Real-time recording of fetal activity in various periods of gestation and the analysis of behavioral patterns have resulted in the detailed description of sequential changes in fetal behavior and provided information about the functional development of the fetal central nervous system. It is generally accepted that patterns of fetal activity reflect the development and maturation of the central nervous system. Therefore, the distinction between normal and abnormal fetal behavior could make possible the detection of discrete structural brain abnormalities. Fetal behavioral patterns throughout gestation and their correlation with structural developmental events are discussed in this review. [ABSTRACT FROM AUTHOR]

Discusses the practice of prenatal testing among general practitioners. Medical aims of prenatal ultrasound screening; Likelihood of giving birth to a child with Down's syndrome; Development of a screening test called '11-14 week scan'; Test characteristics of nuchal translucency screening.

Evaluates the validity and reliability of ultrasonic measurement of bladder volume in postnatal women. Degree of agreement between ultrasonic measurements and catheterized bladder volumes.

The article reports a case of a woman whom at 9 weeks' gestation an ultrasound scan showed a viable triplet pregnancy, a monochorionic diamniotic twins and a singleton. It notes that the singleton was born without a heartbeat and was declared dead, while the twin sisters were both born in excellent condition. The case underlines the need for awareness to the possible development of a diamniotic twin pregnancy into a pseudomonoamniotic pregnancy, can be complicated by cord entanglement.

Demonstrates the appearance of an intrauterine lesion examined with an ultrasound-based virtual hysteroscopy. Improvement of the examination by the use of endovaginal probes; Assessment of the morphology of the intrauterine lesion by analysis of the virtual image; Feasibility of virtual endoscopic reconstruction of three-dimensional ultrasonography.

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]

Presents a case report which described a fortunate monoamniotic twin pregnancy. Background of the case report; Information on monoamniotic twinning; Type of delivery for this case.