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Objectives To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. Methods A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Ultrasound findings and obstetric and neonatal outcomes were reviewed and analyzed. Results Thirty-five cases of vasa previa were identified. Most cases (33 of 35 [94.3%]) were diagnosed antenatally. All 33 cases that followed our screening protocol were diagnosed antenatally and had favorable outcomes. Two cases that did not follow our protocol were not diagnosed antenatally and were delivered emergently. The mean gestational age ± SD at delivery of antenatally diagnosed cases was 34.9 ± 1.69 weeks. All neonates survived. Conclusions Routine ultrasound screening for vasa previa using American Institute of Ultrasound in Medicine criteria will almost universally lead to good outcomes and prevent perinatal mortality.

International audience; As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging.

Purpose Intraabdominal bleeding is a dreaded complication after laparoscopic transabdominal preperitoneal inguinal hernia repairs. Routine postoperative sonographic (US) examination and hemoglobin measurement have been suggested to identify bleeding after surgery. We retrospectively assessed the value of these tests. Methods A total of 995 consecutive patients admitted for laparoscopic inguinal hernia repair to a single teaching hospital were analyzed. US examinations were performed postoperatively on the operative day to identify intraabdominal bleeding. In addition, hemoglobin measurements were obtained on the first postoperative day. Results Postoperative US examinations were performed on 971 patients (97.6%). Of these, 945 were examined within 24 hours of surgery. Reoperation was necessary in 1.1% (11/995) of the patients because of a persistent seroma in five cases, intraabdominal or inguinal bleeding or hematomas in five cases, and a trocar hernia in one case. In none of the 11 patients requiring reoperation did US examination or hemoglobin measurement indicate acute bleeding or hematoma. Conclusions Routine postoperative US examination and hemoglobin measurement within the first 24 hours of surgery are not suitable for identifying patients with intraabdominal bleeding who require a reoperation. Instead, US examination and hemoglobin measurement should be part of the patient workup when there is a clinical suspicion of a postoperative complication. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound, 2016

Background The prognosis and early neonatal management of the VACTERL association depend mainly on the severity of malformations ascertained prenatally. Methods Here we reviewed the spectrum of clinical features observed in cases of VACTERL association ascertained prenatally through ultrasound examination but examined at birth and compared them with cases ascertained postnatally. Results From 1995 to 2011, a total of 19 cases of VACTERL association were observed in our center; 10 were ascertained prenatally and confirmed after birth whereas 9 were ascertained only after birth. The types and frequencies of malformations observed prenatally were as follows: renal malformations (45%), tracheoesophageal fistula (44%), cardiac malformations (20%), vertebral (13%), and limb (11%) defects. Anal atresia was never detected using routine prenatal ultrasound examination. Conclusion Further studies of fetuses with the VACTERL association are necessary to better delineate the malformations spectrum observed prenatally to improve the early recognition of the VACTERL association. Birth Defects Research (Part A) 103:880–886, 2015. © 2015 Wiley Periodicals, Inc.

ObjectiveTo explore procedures for providing information, assessment and documentation about ultrasound soft markers in Sweden. DesignDescriptive, quantitative, cross-sectional survey. SampleEighty-two percent of all obstetric ultrasound clinics in Sweden (covering >90% of routine fetal ultrasound examinations). MethodsPostal questionnaire survey between December 2010 and January 2011. Main outcome measuresItems about provision of information, risk estimation, and follow-up strategies in relation to observed ultrasound soft markers. ResultsMore than 96% of all fetal routine ultrasound examinations were performed at 15-21 gestational weeks, primarily by midwives. Half of the clinics replying wanted prospective parents to be provided with information, but 38 (78%) of the clinics did not routinely inform about assessment of soft markers before the examination. Follow up and decisions on whether to give information when soft markers were found were based on the number and type of the observed markers, whether other structural deviations existed, and on the woman's age and anxiety level. Only at eight clinics (17%) were parents informed about all soft marker findings. At 13 clinics (28%) observed markers were documented/recorded, even though the women were not informed. ConclusionsInformation regarding the assessment and importance of observed soft markers seems to be inconsistent and insufficient. Provision of information and documentation of findings appear to be handled differently at obstetric ultrasound clinics. This suggests that Swedish ethical principles relating to healthcare and ultrasound examinations are incompletely followed and national guidelines appear to be necessary.

Background Bladder exstrophy is a rare malformation. Prenatal diagnosis is usually an incidental finding on routine ultrasound examination. Triple-X syndrome (karyotype 47,XXX) is the most frequent sex chromosome aneuploidy in live-born females (approximately 1 in 1000). The diagnosis is often not made because women with 47,XXX karyotype have no or hardly any clinical symptoms during life. Methods Prenatal diagnosis of triple X karyotype is usually an incidental finding when an invasive prenatal diagnosis is performed for other reasons. Results Here, we report on two cases with bladder exstrophy and triple-X syndrome, one in a fetus and one in an adult. In view of two previous reports of this association in literature, causality of these two conditions should be considered. Conclusion A gene dosage effect as possible underlying mechanisms will be discussed. Birth Defects Research (Part A) 100:797–800, 2014. © 2014 Wiley Periodicals, Inc.

Objectives: The purpose of this study was to determine the accuracy of sonographer predictions of fetal gender during routine ultrasounds. Primarily, the study sought to investigate the accuracy of predictions made in the first trimester, as requests from parents wanting to know the gender of their fetus at this early scan are becoming increasingly common. Second and third trimester fetuses were included in the study to confirm the accuracy of later predictions. In addition, the mother's decision to know the gender was recorded to determine the prevalence of women wanting prenatal predictions. Methods: A prospective, cross sectional study was conducted in a specialist private obstetric practice in the Illawarra, NSW. A total of 640 fetuses across three trimesters were examined collectively by seven sonographers. Fetal gender was predicted using the sagittal plane only in the first trimester and either the sagittal or transverse plane in later trimesters. Phenotypic gender confirmation was obtained from hospital records or direct telephone contact with women postnatally. Results: Results confirmed 100% accuracy in predictions made after 14 weeks gestation. The overall success rate in the first trimester group (11–14 weeks) was 75%. When excluding those scans where a prediction could not be made, success rates increased to 91%. Results were less accurate for fetuses younger than 12 weeks, with an overall success rate of 54%. Male fetuses under 13 weeks were more likely to have gender incorrectly or unable to be assigned. After 13 weeks, success rates for correctly predicting males exceeded that of female fetuses. Statistical differences were noted in the success rates of individual sonographers. Sixty seven percent of women were in favour of knowing fetal gender from ultrasound. Publicly insured women were more likely to request gender disclosure than privately insured women. Conclusions: Sonographic gender determination provides high success rates in the first trimester. Results vary depending on sonographer experience, fetal age and fetal gender. Practice guidelines regarding gender disclosure should be developed. Predictions prior to 12 weeks should be discouraged.

Because there are few published studies from Eastern countries concerning women's experiences of prenatal ultrasound scans, this study investigated this topic in 238 Japanese women in three different prenatal settings. A cross-sectional questionnaire of 33 items was administered to 261 women at 14–37 weeks gestation with no known obstetrical risk, after their ultrasounds. The main reasons for the ultrasounds were evaluation of fetal growth (100%, n = 238); obstetrical conditions (n = 228, 96%); and fetal abnormalities (91%, n = 217). With increasing maternal age, participants worried more about obstetric problems or fetal abnormalities. Many were interested in fetal viability in early pregnancy, and obstetric problems or fetal abnormality in late pregnancy. While most (n = 234, 98%) looked forward to having scans, the majority (n = 235, 99%) wanted to know if their baby had an anomaly, and 72% (n = 171) worried about the detection of abnormalities. Only 50% (n = 118) had obtained information from their care provider. To assist with women's decision-making, prenatal care providers should provide quality information and understand the factors that influence women's concerns.

Objectives To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations. Methods Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were underlying syndrome, genetic abnormality and multiple pregnancy. The survey asked the mother whether she had had any ultrasound examinations before her child was born, whether any of these had shown clubfoot, and whether she would have preferred to find out about her child's clubfoot before birth or after birth. Results Mothers completed 220 (USA, 105 surveys; Austria, 115 surveys) of 401 mailed surveys. The prenatal detection rate was 60% in the USA compared with 25% in Austria (P = 0.001). Overall, 74% of mothers indicated a preference for prenatal diagnosis and 24% indicated a preference for postnatal diagnosis of the condition. Of 92 patients diagnosed prenatally, 96% of mothers indicated a preference for a prenatal diagnosis. Of 128 patients diagnosed postnatally, 58% of mothers indicated a preference for prenatal diagnosis, 38% for postnatal diagnosis and 4% were undecided. Conclusions The diagnosis of clubfoot is still often missed during routine ultrasound examination. When a prenatal diagnosis is made, most mothers appreciate having this information. However, when prenatal diagnosis is missed, a significant proportion of mothers seem to accept the false-negative diagnosis retrospectively. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Background While the incidence of cosmetic filler injections is rising world-wide, neither exact details of the procedure nor the agent used are always reported or remembered by the patients. Thus, although complications are reportedly rare, availability of a precise diagnostic tool to detect cutaneous filler deposits could help clarify the association between the procedure and the underlying pathology. Objectives The aim of this study was to evaluate cutaneous sonography in the detection and identification of cosmetic fillers deposits and, describe dermatological abnormalities found associated with the presence of those agents. Methods We used ultrasound in a porcine skin model to determine the sonographic characteristics of commonly available filler agents, and subsequently applied the analysis to detect and identify cosmetic fillers among patients referred for skin disorders. Results Fillers are recognizable on ultrasound and generate different patterns of echogenicity and posterior acoustic artefacts. Cosmetic fillers were identified in 118 dermatological patients; most commonly hyaluronic acid among degradable agents and silicone oil among non-degradable. Fillers deposits were loosely scattered throughout the subcutaneous tissue, with occasional infiltration of local muscles and loco-regional lymph nodes. Accompanying dermatopathies were represented by highly localized inflammatory processes unresponsive to conventional treatment, morphea-like reactions, necrosis of fatty tissue and epidermal cysts; in the case of non-degradable agents, the associated dermatopathies were transient, resolving upon disappearance of the filler. Conclusions Cosmetic filler agents may be detected and identified during routine ultrasound of dermatological lesions; the latter appear to be pathologically related to the cosmetic procedure.

OBJECTIVE: To investigate parents' expectations, experiences and reactions, sense of coherence and anxiety before and after a second-trimester routine ultrasound examination, with normal findings. METHODS: Before and after ultrasound questionnaires including the scales parents' expectations, experiences and reactions to routine ultrasound examination (PEER-U state of mind index), sense of coherence (SOC) and state and trait anxiety inventory (STAI), were sent to a 1-year cohort of women and their partners. Replies received were 2183. RESULTS: Both parents had significantly less worried state of mind (PEER-U) after the examination than before. Women had a lower grade of state anxiety after than before, but for men there was no significant change. Before the ultrasound, women had a higher degree of worried state of mind, as well as a higher grade of state and trait anxiety and a lower sense of coherence, than men. The women showed a greater reduction in worried state of mind than the men after the ultrasound examination. There were no significant differences in sense of coherence before and after ultrasound. CONCLUSIONS: Women and men are affected in their psychological well-being in relation to a routine ultrasound examination, but their sense of coherence remains stable. Copyright (c) 2009 John Wiley & Sons, Ltd. (Less)

Background: Antenatal care services are well established in Germany, with at least 10 routine antenatal consultations per pregnancy. Although many individual antenatal screening procedures and tests have been assessed in clinical trials, little is known about the overall prevalence of suspicious findings in routine antenatal surveillance and about related effects on psychological maternal well-being. The objectives of this study were to evaluate the views of pregnant women on prevalence, type, and consequences of suspicious findings during antenatal care; to assess related worries and anxiety; and to compare the reports of risk factors by these women with the antenatal records. Methods: We enrolled 360 pregnant women participating in antenatal classes in the Rhein-Neckar area, Germany. They were followed up from the beginning of antenatal classes to the puerperium using self-administered structured questionnaires that covered previous antenatal consultations and related worries. The Spielberger State-Trait Anxiety Inventory was used to assess current and general levels of anxiety. Antenatal records were also analyzed. Postnatally, pregnancy outcomes were assessed by telephone interviews. Results: Two-thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings reported that they were acutely worried. The suspected problem often did not materialize: 13 (81.3%) of 16 suspected malformations and 34 (81%) of 42 suspected growth-retarded babies were in the normal range. Many suspicious findings reported by mothers were not documented in the antenatal records. Conclusions: Contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable worries. More research is needed to evaluate the long-term impact and consequences of suspicious or false screening results in routine antenatal care. (BIRTH 35:1 March 2008)

Aim: The aims of the study were to: (i) compare the accuracy of standard ultrasonic algorithms in the estimation of fetal weight and; (ii) test two new algorithms in order to improve the global performance of birthweight prediction by adding fetal subcutaneous tissue thickness. Methods: We enrolled 398 patients who were between 34 and 42 weeks' gestation. Routine ultrasonographic biometric parameters as well as subcutaneous tissue thickness ultrasound parameters were measured. Correlation matrices between ultrasound parameters, in order to evaluate the degree of multicollinearity between these parameters, were assessed to develop a stepwise multiple regression birthweight predictive model. Results: Contributions of single ultrasound measurements in predicting birthweight were examined, by fitting Log-transformed birthweight versus single ultrasound measurements. We found that the mid-thigh tissue area was able to significantly improve the performance of the birthweight prediction process when added to the other standard ultrasound measurements. We derived two new algorithms which appeared to be better at predicting birthweight. Furthermore there was a lower minimum absolute estimation error noted when compared to other reported formulae. Conclusions: Our algorithms showed that the addition of the mid-thigh tissue evaluation in birthweight prediction was valuable in comparison to birthweight prediction models which are based on routine ultrasound parameters.

Neuroepidemiology, Fondazione IRCCS C. Besta, Milan, ItalyBackground: Ultrasound guidance for central venous cannula-tion is advised by recent guidelines, but is not being applied ineveryday practice. The purpose of this study was to determine thereduction in complications when applying an ultrasound locatingdevice for internal jugular vein catheterization.Methods: An observationalstudy was conducted fromNovember2004 to October 2005 in a tertiary neurosurgical hospital on 300patients undergoing internal jugular vein cannulation using anultrasound technique. Patients were not randomized and operatorswere trained using theoretical and practical courses. Prior to thestudy, the investigators, who were consultant anaesthesiologists,had to perform at least 20 successful supervised cannulations.Results: Cannulation was successful in all cases. The incidence ofarterial puncture was 2.7%, and multiple venous puncturesrepresented the main minor complication (14%). Bivariate analysisof the overall complications revealed nosignificant correlationwithage group, American Society of Anesthesiologists’ (ASA) classifi-cation, body mass index, or position and diameter of the vein.Conclusions: Ultrasound cannulation of the internal jugular veinminimized complications. These could be avoided when newultrasound probes and specific needles are introduced.

Background. To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology.Methods. Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study.Results. Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% accordin...

If you have strong views on any matter related to ultrasound, it is highly likely you will receive a summons to write an editorial on the subject for the White Journal. This editorial is my attempt to justify my frequently expressed opinion that ultrasound is not used effectively in most departments of reproductive medicine and proper use of modern technological developments would improve the quality and costeffectiveness of patient care. In order to make my case, I carried out a survey of British reproductive medicine units to determine how they use ultrasound in their practice. This is an international journal and so I apologise that the survey only involved UK units but I hope the results are nevertheless interesting to international readers of the journal. I asked five specific questions (Table 1) to key members of assisted conception and reproductive medicine centers and received replies from 72 out of the 75 in vitro fertilization (IVF) centers in the UK. In only four centers was color Doppler used in clinical practice to assess uterine blood flow. Three other centers had a color Doppler facility on their machine but no one was trained to use it. Fourteen centers carried out hysterosalpingocontrast sonography (HyCoSy) for assessment of tubal patency and 17 were using saline contrast sonohysterography for the assessment of the uterine cavity. Five centers (predominantly within the National Health Service) were carrying out research projects primarily involving ultrasound and six centers were using routine ultrasound guidance for embryo transfers. Thus it seems that unlike fetal medicine units, reproductive medicine departments have not embraced the latest technological advances despite the fact that there have been over 200 peer-reviewed publications in major scientific journals during the past 10 years demonstrating the use of Doppler to elucidate neoangiogenic events in the reproductive system and the physiological changes during endometrial and

Objectives To determine the impact on maternal anxiety of detecting a soft marker, and the association between anxiety and the information given during the scan. Methods Routine 20-week fetal anomaly scans were audiotaped in the obstetric ultrasound unit of a London teaching hospital, across a four month study period. The study sample comprised 28 pregnant women: 14 in whom a soft marker was detected and a comparison group of 14 women in whom no marker was identified. Telephone interviews were conducted within one week of the scan, at 30 weeks' gestation, and one month after the birth of their children. The main outcome was anxiety, assessed using a standardized scale. Information provided during the scan was coded from transcripts. Results In the week following the scan, women with soft markers had clinically significant levels of anxiety. At 30 weeks' gestation and one month post-partum their levels were within the normal range. Women who were told during their scan that their baby would probably be all right, compared with women not told this, were significantly less anxious and worried about their baby. Conclusions Results from this small longitudinal study suggest that the detection of soft markers on routine prenatal ultrasound causes considerable short-term anxiety for women and that providing reassurance during the scan may prevent some of this anxiety. Copyright © 2002 John Wiley & Sons, Ltd.

Objective To determine the accuracy of ultrasound at 11–14 weeks' gestation in the diagnosis of chorionicity in twin pregnancy. Methods This was a retrospective observational study of data obtained between 1999 and 2010. At the first-trimester routine ultrasound scan, chorionicity was assigned according to the number of placental masses and T or λ-signs for a single placental mass. Chorionicity was confirmed by histology or discordant sex at birth. Results A total of 648 pregnancies were assigned chorionicity by first-trimester ultrasound during the study period. Chorionicity was ascertained in 613 cases, either by histology (n = 340) or discordant sex (n = 273). Chorionicity was correctly assigned by ultrasound at 11–14 weeks in 612 of 613 pregnancies (accuracy 99.8%). Sensitivity and specificity for determining monochorionicity were 100% and 99.8%, respectively. Conclusions First-trimester ultrasound can be used to determine chorionicity reliably by noting the number of placental masses and T or λ-signs. Determination of twin chorionicity is important and should be completed in the first trimester. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

The patient was a 26-year-old primigravida who underwent routine ultrasound examination at gestational week 18 + 3 according to last menstrual period.The pregnancy had been uneventful with no signs...

We present an antenatal ultrasonographic diagnosis of the cerebro-costo-mandibular syndrome. This rare dysmorphic disorder (only 51 cases have been reported to date) mainly associates defective costal development with features of the Pierre-Robin syndrome. The diagnosis is very often made at birth and the prognosis is very poor. Antenatal ultrasound examination may show a combination of orofacial and chest maldevelopment. In our case the diagnosis was made at 20 weeks' gestation during a routine ultrasound examination and the patient chose to terminate the pregnancy at 24 weeks.

The use of routine obstetric ultrasound has been shown to accurately diagnose fetal gastrointestinal anomalies, both during and after the midtrimester. These are among the most accurately diagnosed of all anomalies, comprising 5-7% of all fetal anomalies. From a review of the literature it is clear that the use of routine ultrasound allows: (1) the detection of multiple anomalies that are often present and affect outcome significantly, (2) preparation for delivery at a tertiary center where neonatal surgical experience will allow optimal outcome, and (3) decisions about mode and timing of delivery in cases where this is important, i.e., cases of omphalocele and gastroschisis.

In this prospective study, we recorded details on 3,685 fetuses with congenital structural abnormalities from an unselected population of women who underwent routine ultrasound examinations during their pregnancies. Overall, 2,262 fetuses were diagnosed as being abnormal before birth (sensitivity = 61.4%). The total number of abnormalities was 4,615, of which 1,733 (37.5%) were major abnormalities. The overall number of detected abnormalities was 2,593 (sensitivity = 56.2%). If only major abnormalities were considered, the sensitivity rose to 73.7%, compared to only 45.7% for the minor abnormalities. Within each severity group, the accuracy of detection varied across systems. For the major abnormalities, it was higher for the central nervous system (88.3%) and urinary tract (84.8%), but lower for heart and great vessels (38.8%). Detection of minor abnormalities was also effective for the urinary tract (89.1%), but not for the heart and great vessels (20.8%) and the musculoskeletal system (18%).

Screening has been defined as “the systematic application of a test or enquiry, to identify individuals at sufficient risk of a specific disorder to benefit from further investigation or direct preventive action, among persons who have not sought medical attention on account of symptoms of that disorder” (Wald, N.J. 1994. J. Med. Screen. 1: 76). The purpose of screening is to benefit the individuals being screened. The early detection of abnormalities should not be an end in itself, and the value of a screening approach needs to be determined before it is introduced into practice. Ultrasound as a means of screening for fetal abnormalities has not been adequately assessed even though it is widely used in this way. To assess its value it is helpful to classify abnormalities that can be detected on the basis of the clinical usefulness of doing so. To this end we propose four categories similar to those independently suggested by the Royal College of Obstetricians and Gynaecologists Working Party on Ultrasound Screening for Fetal Abnormalities. Four groups were specified: (A) major abnormalities-death inevitable, (B) abnormalities associated with long-term handicap, (C) abnormalities potentially amenable to intrauterine treatment, and (D) fetal conditions that require immediate postnatal investigation and/or treatment. For each abnormality, the screening detection and false-positives need to be estimated together with the medical and financial costs of screening, particularly those arising from findings of uncertain or little medical consequence that may lead to worry and further unnecessary obstetric intervention.

The aims of this study are (1) to evaluate the efficiency of ultrasound in detecting CA in low-risk populations of pregnant women by routine screening performed in hospital ultrasound labs (level II); (2) to highlight the areas where improvement could be obtained; (3) to determine efficient timing and number of examinations; (4) to evaluate the psychological returns of detection and nondetection of CA; and (5) to evaluate the cost-effectiveness ratio of antenatal screening of CA. A European collaboration was supposed to help in meeting these objectives because results concerning the analysis of individual CAs or groups of CAs can only be statistically significant when their number is sufficiently large. It was estimated that it was necessary to collect nearly 5,000 CA; this corresponds to about 200,000 pregnant women, the prevalence of malformations at birth being estimated at 2.5%. These conditions yield worthy conclusions, given the following circumstances: a large variety of CA, the extremely low incidence of each CA, the multiple approaches for diagnosis and management, the manifold classes of defects, the differences in gestational age when anomalies are detectable and detected. We study prospectively (1) the reliability of ultrasound in detecting antenatal malformations by recording all CA, ultrasonically suspected and not; (2) the gestational age of anomaly recognition; (3) the response to antenatal diagnosis of CA; (4) the individual outcome of pregnancies; (5) the financial cost of the screening program; and (6) the psychological consequences for the parents.

To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.Follow up of eight to nine year old children born to women who participated in a randomised controlled trial on ultrasound screening during pregnancy.Nineteen antenatal care clinics run by three central hospitals in Sweden from 1985 to 1987.Of 4637 eligible singleton pregnancies, 3265 (71%) were followed up through a questionnaire sent to their mothers. Analyses were performed both according to randomised groups and to ultrasound exposure.Parents' report of vision and hearing tests as recorded on child's record card. Parents' report of their child's weight and height at 1, 4 and 7 years of age.Reduced hearing was reported by 3.4% in the screening group compared with 3.5% in the nonscreening group (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.67-1.41). The same prevalences were found when analysed according to ultrasound exposure (OR 1.0; 95% CI 0.67-1.42). Reduced vision was reported by 6.3% in the screening group compared with 7.8% in the nonscreening group (OR 0.8; 95% CI 0.60-1.03). Corresponding figures for ultrasound exposed and unexposed were 6.2% and 8.0%, respectively (OR 0.8; 95% CI 0.58-1.00). No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children or between exposed and unexposed were found.This study found no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.

We describe new charts and tables for dating pregnancies derived from data collected in a study designed to enable the construction of these and charts of fetal size. This was a prospective study in which 663 fetuses seen in the routine ultrasound clinic in a London teaching hospital were scanned once only for the purpose of this study. We discuss the statistical methodology in detail and compare the new charts with other published charts. We suggest that the differences seen may be due to variation in study methodology.

The aim of this study was to evaluate pre-scan counselling and the provision of information to parents-to-be, and their expectations before and experiences of a second trimester routine ultrasound scan. In the study, 303 pregnant women and their partners were asked to complete questionnaires before and after the scan. The main purposes of the examination were: dating, ascertaining fetal viability, and detection of multiple gestations. Although scanning for fetal malformations was not the purpose of the examination, 89% of the women and 84% of the men were concerned about this aspect. Even though it has been postulated that more women would not attend the examination if they knew it was for prenatal diagnostic purposes, the results of this study did not support this assumption. Only 57% of the women had received information at their antenatal care centers. A total of 138% of the women and 85% of the men said that they obtained sufficient information at the scan. Anxiety was low before the scan, both among women and men, with the exception of those women who had experienced problems at earlier scans. Positive feelings dominated during the scan and these feelings remained when experiences of the scan were reported by the parents-to-be after they had gone home. It is concluded that a routine second-trimester scan is a positive event for the majority of the participating women and men. In spite of this, we believe that certain measures should be taken to improve pre-scan counselling and the provision of adequate information. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology

A dataset of 64 pregnancies conceived by artificial reproductive techniques was studied to assess the accuracy of second-trimester dating formulae when these were applied in routine ultrasound clinics in different centers. Dating formulae for biparietal diameter (BPD) and femur length (FL) were derived for a gestational age range of 14–23 weeks. The best fit curves represented linear equations: gestational age (days) = 44.2 + 2 × 13PD; and gestational age (days) = 67.4 + 2.3 × FL. Twelve published formulae for biparietal diameter and femur length were reviewed and systematic and random errors were calculated for these formulae when they were applied to second-trimester scan measurements in precisely dated pregnancies. Overall, published dating formulae performed well in predicting gestational age. The 95% confidence interval was 8.3 days for biparietal diameter and 10.2 days for femur length. The study confirms the accuracy of ultrasound dating in routine ultrasound clinics and supports the use of ultrasound measurement alone in preference to menstrual history for dating pregnancy. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology

The quality of prenatal ultrasound may be influenced by different factors. In this study, the influence of the experience of the investigator on the quality of routine ultrasound screening during pregnancy was evaluated. We related the detection rate of fetal malformations in routine ultrasound screening in the region of Vienna to the experience level of the examiner. All 323 cases of fetal malformations registered by the obstetrical departments of Vienna or registered by the Vienna perinatal mortality statistics of 1990 and 1991 were evaluated. For analysis we used the medical charts or the patient-held antenatal records ("Mutter-Kind-Pass'). Obstetricians in private offices (level I) detected 22 per cent, the examiner in the hospital (level I-II) 40 per cent, and the examiner in the centre for prenatal diagnosis and therapy (level III) 90 per cent of all fetal malformations. The detection rate before the 24th week of gestation was significantly different (25 per cent vs. 34 per cent vs. 58 per cent). Our results suggest that an important factor for the quality of prenatal ultrasound investigation is the education of the sonographers. Furthermore, each pregnant woman should undergo ultrasound screening once in a level II or III centre before 24 weeks or before fetal viability.

Ultrasound screening for fetal abnormalities is increasingly becoming part of routine antenatal care in Europe and the UK. However, there has been very little formal evaluation of this practice. In this article reports of routine ultrasound screening are reviewed and the advantages and disadvantages discussed. The majority of routine anomaly scanning is done in the second trimester but there may be a case for screening at other times in pregnancy and alternative anomaly screening policies are discussed.

Five ultrasound laboratories from Obstetrics and Gynecology departments of Belgian university hospitals or affiliated institutions conducted a prospective study from 1984 to 1992 in which the results of prenatal ultrasound examinations were compared to examination reports of the neonates. The results of the period 1984–89 (PI) have been published previously, and those of the period 1990–92 (PII) are presented here. Some very minor congenital anomalies, as listed. and defined in the EUROCAT Register, were excluded. Of 26 147 pregnant women at normal risk for congenital anomalies, 25 046 had at least one ultrasound scan (96%). A total of 616 fetuses were structurally abnormal (prevalence 2.42%), and 685 abnormalities were recorded. The sensitivity of the ultrasound test was 40.4% in PI and 51.1% in PII for abnormal fetuses (p < 0.05) and 45% (PI) and 64% (PII) for abnormalities (p < 0.01). The specificity was 99.9%) and the positive and negative predictive values were 94.2% and 98.6%, respectively; these values did not differ significantly between the two periods. The sensitivity for the detection of anomalies before 23 weeks increased from 21% in PI to 41% in PII, indicating an improvement in the early detection of fetal abnormalities. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology

OBJECTIVES: To discuss and evaluate the management of ovarian masses in women over 70. METHODS: The nature of adnexal masses and the outcome of surgical intervention in 38 women over 70 was reviewed. RESULTS: There were seven cases of malignant ovarian tumors in our series of 38 patients reviewed. The most frequent presenting sign was abdominal pain (11 cases). The presence of an adnexal mass was suspected on the basis of routine gynecologic examination in 8 cases, whereas by routine ultrasound scan in 30 patients. Postoperative complications were rare. CONCLUSIONS: It is suggested that in all postmenopausal women routine yearly pelvic examination and ultrasound scan is advisable. Furthermore, in view of our favorable results in recent years, we feel that surgical intervention is justified in all cases of adnexal tumors in the woman over 70.

The four-chamber view of the fetal heart is reported to he the most useful view for detecting congenital heart defects. In 7322 non-selected, consecutive pregnancies of women attending a second-trimester (18 weeks) routine ultrasound scanning program, we examined our ability to obtain a four-chamber view in the fetus within the 30 min generally allocated to do the scan and record data. Five trained nurse-midwives performed the examinations between June 1988 and September 1990. In the first part of the study, a four-chamber view could not be obtained in 7%, while in the second part, the failure rate was 4%, which showed a learning effect over time. The demonstration of a four-chamber view was significantly better with a 5 MHz than with a 3.5 MHz transducer. The ability to obtain the four-chamber view improved as the gestational age increased. The main reason for not being able to obtain the four-chamber view with the 3.5 MHz transducer was poor imaging; for the 5 MHz transducer, it was an unfavorable position of the fetus. Education and experience, as well as good equipment, are important factors in obtaining good results. The time spent learning to obtain a four-chamber view reliably was relatively long.

Evaluation of the precision of routine ultrasound term prediction.Population based follow-up without intervention.Ultrasound screening in routine clinical practice.1650 women residing in one Norwegian county giving birth during a 12-month period. All pregnancies were singleton with spontaneous onset of labor, all records contained a term predicted with routine ultrasound in the second trimester.Difference between actual and predicted day of delivery, and difference between ultrasound predicted term and term calculated from last menstrual period.More women delivered within two weeks of ultrasound term than two weeks of term calculated from the last menstrual period (87.5% and 79.3%, p0.001). Deliveries were significantly closer to the ultrasound predicted term than the term calculated from the last menstrual period, with the exception of deliveries in the 39th week after LMP where no significant difference was found between ultrasound term and LMP-term. No difference was found in the mean performance of 14 different ultrasound operators.In a population representative of deliveries in one county, routine ultrasound term prediction performed in three medium sized hospitals more accurately predicted day of delivery than term calculated from the date of last menstrual period.

PREAMBLE: Prenatal screening by ultrasound is increasing in the United States. In 1990, 52 percent of mothers who had live births received ultrasound, compared with 48 percent in 1989 (Monthly Vital Stat Rep 1993;42:2(S):6). A recent multicenter, randomized study of 15,151 low-risk pregnant women, conducted by the Routine Antenatal Diagnostic Imaging With Ultrasound (RADIUS) Study Group, reported no significant differences in pregnancy outcomes between women who received no ultrasound scan and women who received two scans during pregnancy (N Engl J Med 1993;329:821–827). Ewigman et al concluded, “The adoption of routine ultrasound screening in the United States would add considerably to the cost of care in pregnancy, with no improvement in perinatal outcome.” This interview and discussion took place at the Tenth Birth Conference, October 31-November 1, 1992, in Boston. It was conducted by Max Allen, producer, Canadian Broadcasting Corporation, and broadcast as part of a radio program, “Birth and Technology,” on CBC Ideas, February 15, 1993.

Objective To assess the efficacy of four chamber view examination, during routine obstetric scanning, in the prenatal detection of fetuses with congenital heart disease. Design Prospective observational study. Setting Ten obstetric ultrasound units in the South East Thames Region. Subjects All pregnant women attending for routine obstetric ultrasound examination. Intervention Ultrasonographers performing routine ultrasound examinations were taught to obtain, and correctly interpret, the four chamber view of the fetal heart. When this view could not be achieved adequately, an attempt was made to identify a reason for failure and, if possible, to arrange a repeat scan. All suspected abnormalities were referred to a specialized unit. Main outcome measures Numbers of true abnormalities detected or overlooked, and the number in whom abnormality was suspected incorrectly. Results Over a 2.5-year period, 69% of the known number of cardiac lesions associated with an abnormality of the four chamber view were detected prenatally during the routine obstetric scan, 10% were identified as a result of referal for other high-risk factors and 21% were overlooked. The overall positive predictive value in the 10 obstetric units was 36%. Conclusions Prenatal screening for some forms of major congenital heart disease is possible by including examination of the four chamber view of the fetal heart in routine obstetric scans. However, there are important limiting factors that will influence the success of abnormality detection and must be taken into account if screening is to be effective nationwide.

Three cases of intrathoracic hyperechogenic areas on fetal ultrasound are described. Two apparently resolved spontaneously and the infants are alive at 1 year and 7 months, respectively. The third infant was found to have a pulmonary sequestration of the extra-lobar variety which required surgical resection.

We report the case of dicephalic conjoined twins discovered incidentally on a routine ultrasound at 24 weeks of gestation. There were 2 heads and a neck that fused with 1 thorax, but the spines continued all the way to the coccyx. The spines were connected medially by a fused rib, and laterally, there were ribs that went around the thorax in a more normal fashion. Antenatal ultrasound images are supplemented by postnatal photographs and x-rays. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

SUMMARY The antenatal diagnosis of a thoracic neurenteric cyst with vertebral abnormality during routine ultrasound is described here. The diagnosis was made at 34 weeks gestation but with hindsight, the abnormality was visible on the 18-week scan. To the knowledge of the authors, this is the first recorded instance of the antenatal demonstration of a neurenteric cyst with a vertebral anomaly. With modern high-resolution machines it is possible to detect the abnormality at as early as 18 weeks gestation. As a result of early diagnosis, the mother could be counselled and both the mother and the obstetrician could be better prepared to manage the pregnancy and take early remedial action before the onset of complications, to obtain the best possible outcome for all concerned.