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Objective: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. Methods: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf’s method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ? 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. Results: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). Conclusion: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period. Level of Evidence: Level II, Diagnostic Study WOS:000657568500003 2-s2.0-85107884459 PubMed: 34100358

A previously healthy 27-year-old gravida 1, para 0 woman is admitted with preterm labor and loss of fluids at 28 weeks’ gestation. She receives antenatal steroids and obstetric ultrasonography shows bilateral cerebral ventriculomegaly and an absent stomach bubble. Before admission, her pregnancy had been uneventful and findings on early anomaly screening ultrasonography at 19 weeks’ gestation are normal. Serologic tests for maternal group B Streptococcus , cytomegalovirus, toxoplasma, and Treponema all have negative findings. The fetal tracing becomes non-reassuring and the neonate is born via emergency cesarean delivery. The neonate has apnea, hypotonia, and bradycardia at birth and does not respond to face mask ventilation. He undergoes intubation by 5 minutes after birth, with improvement in his heart rate, but he remains limp without any spontaneous breathing. His Apgar scores are 1, 2, and 3 at 1, 5, and 10 minutes after birth, respectively. Arterial and venous cord blood gases are 7.29 pH and 7.36 pH. Initial examination shows a preterm infant with appropriate weight, length, and head circumference for age, decorticate posturing, hypotonia of the lower extremities, …

Amaç: Çalışmamızın amacı Trakya Üniversitesi Tıp Fakültesi Doğum Kliniğinde Mayıs 2016 –Aralık 2018 tarihleri arasındaki 2,5 yıllık zaman aralığında terminasyon yapılan gebeliklerin endikasyonlarının dağılımını değerlendirmek ve 10 (on) hafta üzeri gebelik sonlandırmasında dört saatte bir intravajinal ve yirmi dört saatte bir vajinal yolla uygulanan sırasıyla 400 μg ve 600 μg mizoprostolün etkinliğini karşılaştırmak. Gereç ve Yöntem:Retrospektif dosya incelemesi şeklinde planlanan çalışmamızda kliniğimizde terminasyon kararı verilen 10 (on) hafta üzeri gebeliklerin sonlandırılma endikasyonları ve uygulanmakta olan mizoprostol tedavi protokollerinin etkinliği incelendi. 18-45 yaş arası, 10 (on) hafta ve üzeri olan gebeliklerin sonlandırılmasının planlandığı toplam 128 kadının dosyası değerlendirildi. 63 hastaya (Grup 1) 4 saat ara ile tekrarlanan 400 μg vajinal yolla mizoprostol uygulandı. 65 hastaya (Grup 2) 24 saat ara ile tekrarlanan 600 μg vajinal yolla mizoprostol uygulandı. Her iki grupta yeterli uterin kontraksiyon elde edilene kadar doz tekrarlanıp 48 saat sonrasında abortus/doğum gerçekleşmemesi halinde yöntem başarısız olarak kabul edildi. Bulgular: Çalışmamızda termine edilen 128 hastanın terminasyon endikasyonları belirlendi. Gebelik terminasyon endikasyonları: Missed Abort ve IUGR (in utero mort fetus) 32(%25), santral sinir sistemi anomalileri 30(%23,4), anhidramniyoz 28(%21,8), kromozal anomaliler 11(%8,5), kardiyak anomaliler 7(%5,4), çoklu sistem anomalileri 6(%4,6), kas iskelet anomalileri 5 (%3,9), gastrointestinal ve genitoüriner sistem anomalileri 5(%3,9), teratojen ilaç kullanımı ve radyasyona maruz kalma 4(%3,1) bulundu. Grup 1 olgularda 48 saatte abortus oranı (%90.4) idi. Grup 2 olgularda 48 saatte başarı oranı ise (%92,3) bulundu.Sonuç: İlk trimester ve ikinci trimesterde yapılan obstetrik ultrasonografi fetal yapısal anomalilerin tanısında tek yöntemdir. Santral sinir sistemi anomalileri fetal anomaliler içerisinde en büyük grubu oluşturmaktadır. Hastanemizde 10 (on) hafta ve üzeri gebelik sonlandırılmasında kullanılan mizoprostolün etkili ve güvenilir olduğu düşünülmektedir.

Background: The antepartum estimation of foetal weight is a major determinant of the route of delivery and this has become vital in modern day obstetrics. The limitations to the use of obstetric ultrasonography, considered as the gold standard in estimating foetal weight, make clinical estimation methods attractive alternatives, especially in resource- constrained settings where many un-booked women may report for delivery. Aim: To determine the reliability of intrapartum clinical foetal weight estimation in predicting the actual birth weight (ABW) and route of delivery among term parturient. Setting: The study was conducted at the Sacred Heart Hospital, Lantoro, a voluntary mission agency hospital in Southwest Nigeria. Methods: This cross-sectional study was conducted among 291 term parturient recruited by systematic random sampling between June and September 2017. The clinical estimation of foetal weight was carried out using Johnson’s formula. Results: The accuracy of Johnson’s formula to predict the ABW was 59.5%; while for the mode of delivery, it was 130 (75.1%) for spontaneous vaginal delivery (SVD) and 43 (24.9%) for caesarean section (CS). The sensitivity of the accuracy of Johnson’s formula to predict the mode of delivery was 75.1%, with a specificity of 35.6%, a positive predictive value (PPV) of 63.1%, and a negative predictive value (NPV) of 49.4%. Conclusion: The intrapartum clinical foetal weight estimation at term determined by Johnson’s formula was reliably predictive of ABW and SVD, but it was unreliable in predicting the need for a CS.

Background: Syphilis is one of the most serious sexually transmitted diseases worldwide, and has tremendous consequences for the mother and her developing fetus if left untreated. The burden of morbidity and mortality due to congenital syphilis is high. Purpose: Screening and prompt to know the importance of treatment of syphilis during pregnancy. Case: A 32-year-old multigravida in 5 months of pregnancy presented with multiple raised lesions over her labia. It was accompanied by fluor and smelly fishy odor. There was no history of genital ulcers in either spouse and no history of sexual promiscuity. History of antenatal care in public health showed non-reactive status of HIV, syphilis and hepatitis B. Clinical examination revealed multiple flat, moist warts over her labia mayora and minora, and multiple roseola syphilitica on the plantar pedis sinistra. Darkfield microscopic examination presence spirochete, venereal disease research laboratory (VDRL) titer was 1:16 and T. pallidum particle agglutination assay (TPHA) titer was 1:2560. Obstetric ultrasonography examination was suggestive no mayor congenital abnormalities. Both of serology VDRL and TPHA were non-reactive in her husband. Significant of lesion improvement and decrease a fourfold titer serologic in VDRL (1:4) and TPHA (1:320) as follow-up 3 months after being treated with single intra-muscular injections of benzathine penicillin 2.4 million units. Discussion: Coordinated prenatal care and treatment are vital. It’s implemented before the fourth month of pregnancy to reduce vertical transmission and all associated side effects of congenital syphilis. Penicillin is highly efficacious in maternal syphilis and prevention of congenital syphilis. Conclusion: Universal screening and adequate pregnancy care must be a priority.

Zika virus (ZIKV) is a widespread flavivirus transmitted to humans through the bite of Aedes mosquitoes. The number of ZIKV cases increased significantly between 2015 and 2016, and Brazil was the first to report autochthonous transmission of infection. The main neurological disorder related to ZIKV infection is microcephaly. Fetal magnetic resonance imaging (MRI) is the gold standard examination for the analysis of fetal brain infection, followed by obstetric ultrasonography. Cerebral atrophy, intracranial calcifications, ventriculomegaly, cerebellar, and brain gyrus abnormalities are some of the most common findings. Postnatal MRI shows high sensitivity and specificity. Corpus callosum abnormalities, cerebellar hypoplasia, and choroid plexus dilation can be also observed. We present a review of congenital ZIKV infection with emphasis on pre and postnatal brain findings using ultrasonography, MRI, computed tomography, and three-dimensional reconstruction models.

Background After a traumatic injury, the provision of appropriate, timely care to pregnant women jury is crucial for the health of both the mother and fetus. The aim of this study was to identify risk factors predicting post-traumatic obstetric complications in pregnant women who presented to the emergency department (ED) with traumatic injuries. Methods We conducted a retrospective cohort study of pregnant women aged 18 y and older who were admitted to the trauma unit of our ED between 2017 and 2020. The data collected included maternal demographics, trauma mechanism, and pregnancy outcome. The patients were divided into two subgroups according to the presence or absence of trauma-related complications, and clinical features were compared between the two groups. Results In total, 241 pregnant trauma patients were included in the study. The mean maternal age was 26.1 ± 4.4 y, and the mean gestational age the time of the trauma was 28.4 ± 6.8 wk. In the study, 17.8% (43/241) of patients experienced obstetric-related complications within the first 24 h post-trauma. The risk factors associated with obstetric complications were aged older than 35 y (odds ratio [OR] = 5.31,95% confidence interval [CI]: 1.77–15.96, p = 0.003), third trimester trauma (OR = 2.41,95% CI:1.14–5.12, p = 0.021), and abnormal obstetric ultrasonography (OR = 6.25,95% CI:2.03–19.22, p = 0.001). Conclusion Among pregnant patients who present to the ED after a traumatic injury, advanced maternal age, trauma in the third trimester, and abnormal obstetric ultrasonography findings should alert physicians to the possibility of post-traumatic complications (within the first 24 h after trauma) and the need for close monitoring.

Ultrasound is the leading technology to monitor the progress of pregnancy and the fetal condition. This chapter presents the basic principles of ultrasound, including the generation of ultrasound pressure waves through electromechanical conversion, their propagation through lossless and lossy media, and the formation of ultrasound images using array transducers. Special attention is dedicated to the resolution of the imaging system, which affects the accuracy of the morphological measurements performed during pregnancy. Besides imaging, ultrasound Doppler principles have provided important solutions for the estimation of blood velocity. The available solutions, ranging from continuous- to pulsed-wave Doppler, up to more advanced color and power Doppler, are presented and critically discussed for their advantages and limitations in pregnancy. The last part of the chapter is dedicated to the clinical use of ultrasound in pregnancy. The main ultrasound tests are presented in chronological order from the first to the third trimester of gestation, monitoring pregnancy progression from embryo development all the way to labor and delivery. Latest developments, such as dynamic 3D and ultrafast imaging, are also briefly presented, along with their expected impact on pregnancy monitoring.

In 2015 Zika virus (ZIKV) emerged for the first time in South America. The following ZIKV epidemic resulted in the appearance of a clinical phenotype with microcephaly and other severe malformations in newborns. So far, mechanisms of ZIKV induced damage to the fetus are not completely understood. Previous data suggest that ZIKV may bypass the placenta to reach the fetus. Thus, animal models for ZIKV infection are important to facilitate studies about ZIKV infection during pregnancy. Here, we used ultrasound based imaging (USI) to characterize ZIKV induced pathogenesis in the pregnant Type I interferon receptor-deficient (IFNAR-/-) mouse model. Based on USI we suggest the placenta to be a primary target organ of ZIKV infection enabling ZIKV spreading to the fetus. Moreover, in addition to direct infection of the fetus, the placental ZIKV infection may cause an indirect damage to the fetus through reduced uteroplacental perfusion leading to intrauterine growth retardation (IUGR) and fetal complications as early as embryonic day (ED) 12.5. Our data confirmed the capability of USI to characterize ZIKV induced modifications in mouse fetuses. Data from further studies using USI to monitor ZIKV infections will contribute to a better understanding of ZIKV infection in pregnant IFNAR-/- mice.

Aim: The association between echogenic intracardiac focus (EIF) and fetal aneuploidy is well established, with a recognized ethnic variation. This study aimed to investigate the prevalence of EIF in Turkish pregnancies and examine its association with fetal aneuploidy and adverse pregnancy outcomes. Material and Methods: We conducted a retrospective cohort study of second-trimester obstetric ultrasonography (16–24 weeks) at a university hospital for over 4 years. During the evaluation, all pregnancies with and without EIF were divided into three groups; Group 1: control group (randomly selected patients without EIF, n = 100); Group 2: isolated EIF group, (EIF is the sole finding, n = 45) and Group 3: non-isolated EIF group, (EIF with accompanying other ultrasound findings for fetal aneuploidy and/or presence of congenital anomalies, n = 21). The pregnancy outcomes of patients with isolated and non-isolated EIF and control group were compared. Results: Overall, 2590 obstetric sonograms were examined, with an EIF prevalence of 2.55%. The presence of other ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased risk of fetal aneuploidy, and 2 of 21 (9.5%) pregnancies in the non-isolated EIF group had fetal aneuploidy. In addition, non-isolated EIF was associated with perinatal mortality, preterm delivery, and polyhydramnios when compared to controls and isolated EIF pregnancies. There was no difference in the pregnancy outcomes between control and patients with isolated EIF. Conclusion: EIF is a rare occurrence in Turkish pregnancies and as a sole finding, it is not associated with fetal aneuploidy or other adverse pregnancy outcomes. However, the presence of ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased rate of fetal aneuploidy and adverse pregnancy outcomes.

Hypertension and proteinuria in pregnant women are most commonly signs of preeclampsia which develops after 20 weeks of gestation. There are rare incidences of uncontrolled hypertension and nephrotic range proteinuria even in the first trimester of pregnancy which can be indicators of severe underlying fetal and placental abnormalities rather than preeclampsia. A G2P0 30-year-old Caucasian woman was admitted to University Hospital for the incidental finding of severe hypertension and proteinuria during her regular prenatal checkup at 14 weeks. She had complaints of mild bifrontal headache, facial and lower extremity edema. Her admission blood pressure was 193/108 mmHg, she had 8 g proteinuria, normal creatinine, and negative immunological and infectious workup. Further evaluation with dedicated obstetric ultrasonography showed hydropic placenta and fetus with aneuploidy. These findings strengthened the suspicion for a rare disease process called mirror syndrome, and emergent delivery was done to treat maternal disease process. Mirror syndrome is a rare disease that occurs basically due to fetal/placental pathology. It can present at any gestational period, and the clinical features include edema, proteinuria, and hypertension, mimicking preeclampsia. Prompt diagnosis and treatment is very crucial to prevent maternal complications. .

Aim The Council of Forensic Medicine is an institution affiliated with the Ministry of Justice in the Republic of Turkey which acts in an official oversight capacity in cases of alleged medical malpractice in forensic medical science. Sonographers may face judicial sanctions as a result of ultrasonography examinations that they do not perform according to current guidelines. In this study we focused our attention to claims of medical malpractice related to obstetric ultrasonography that had been referred to the Council of Forensic Medicine. Our aim was to investigate the causes of malpractice claims related to obstetric ultrasonography and to present the expert opinions of our council about these claims in the light of literature. We have also planned to discuss what can be done with current guideline information to prevent situations that cause malpractice claims. Materials and methods The study herein was performed on 73 claims of medical malpractice in obstetric ultrasonography findings, all of which were referred by forensic authorities to the Second Specialization Board of Council Forensic Medicine from 2014 to 2018. A retrospective review of the reports generated from information contained within case files illuminates the reasoning behind medical error claims. Among the reasons examined are features of the ultrasonographic evaluation (number, week of examination, health institution), the traits of the evaluating physicians (institutions, branches, academic titles), congenital anomalies detected after birth, and maternal age. Results Analysis of the data shows that 79.5% of ultrasonographic examinations leading to claims of medical malpractice were performed in private health institutions. All cases of medical malpractice claims were associated with undiagnosed congenital anomalies, and that the form for informed consent was obtained for only 19.1% of cases that underwent second level ultrasonographic examination. Further, 53.3% of cases with congenital anomalies subject to litigation were anomalies of the extremities, and all four cases of alleged malpractice within obstetric ultrasonography were associated with extremity anomalies. The variety of academic titles of physicians performing the ultrasonographic examinations was not statistically significant. It was concluded that two ultrasonography examinations performed by two nuclear medicine specialists were not in accordance with medical norms. Conclusion Although organizations such as AIUM, ACR, and ACOG try to set standards for ultrasound examination through practice guidelines, it is difficult to establish optimal standards for ultrasonographic examination. In light of the guidelines created by the above organizations, each country should set its own standard based on their own socioeconomic and health data. We conclude that it is not appropriate for obstetric ultrasonographic examinations to be performed by specialists in fields such as nuclear medicine, where ultrasonographic examinations are not a part of the core training curriculum. Obtaining a signed informed consent form from the patient prior to the second level ultrasonography examination will be useful for medicolegal defense purposes should a subsequent claim of malpractice be filed.

Background Congenital heart diseases (CHD) are dynamic defects that originate in the embryo, evolving during gestation, and undergoing significant change throughout the entire course of extrauterine life. CHD represent a complex group of abnormalities related to high infant morbidity and mortality. Ultrasonography advances in Obstetrics and Fetal Medicine have contributed to the increased detection of these anomalies, with high screening potential during pregnancy. Despite studies pointing to high fetal echocardiography's sensitivity and specificity, this method is not homogeneously available worldwide yet, particularly in low and medium-income countries. Objectives Here we compared the accuracy of obstetric ultrasonography performed between 18 and 22 weeks of gestational age with Fetal Echocardiography. Methods We evaluated 44 pregnant women who underwent fetal echocardiography examination. This way, we can comprehend if the first method alone can diagnose fetal cardiac abnormalities or track those that need additional imaging by fetal echocardiography. Results In our sample, Obstetric Ultrasonography reached 81.8% accuracy, 57.1% sensitivity, and 93.3% specificity, whereas Fetal Echocardiography's accuracy was estimated at 97.7%, 100% sensitivity, and 96.8% specificity. Conclusions Despite the superior accuracy of Fetal Echocardiography, we believe that Obstetric Ultrasonography is enough to establish a probable diagnostic hypothesis when performed by experienced professionals, following the specific guidelines. This way, appropriate referral to tertiary centers can facilitate the care of these infants with complex heart disease that requires aggressive surgical intervention and Neonatal and Cardiac Intensive Care services.

Amaç: Suçiçeği enfeksiyonu kaşıntılı, makülopapüler, veziküler, püstüler döküntüler ve kuru cilt ile karakterize bulaşıcı bir hastalıktır. Gebelikte morbiditelere neden olabilmektedir. Bu makalede gebeliğin 19. haftasında VZV enfeksiyonu belirtileri göstermeye başlayan hastanın takibi ve tedavisinin sunulması amaçlanmıştır.Vaka: Olgumuz 19 haftalık gebe kadındı. G2, P1, 31 yaşındaydı. Veziküler ve kaşıntılı lezyonları bulunan hastaya dermatoloji konsültasyonu sonucunda karakteristik lezyonlar nedeniyle suçiçeği tanısı konuldu. Varisella tedavisi için antiviral tedavi başlandı. Obstetrik ultrasonografide intrauterin varisella enfeksiyonu bulgusu olan mikrosefali, ekstremite hipoplazisi, intrauterin büyüme geriliği gözlenmedi. İzlemin 37. Haftasında doğum gerçekleşti. Bir anormallik gözlenmeyen yenidoğan taburcu edildi, taburculuk sonrası kontrollerde anormal bir bulguya rastlanmadı.Sonuç: Antenatal dönemdeki suçiçeği enfeksiyonu anne ve fetus için ciddi komplikasyonlarla ilişkilidir. Suçiçeği enfeksiyonu geçiren olan gebeler için antiviral tedavi olarak oral asiklovir tek başına veya VZIG ile kombinasyon edilerek faydalı olabilir.Anahtar Kelimeler: Varicella-Zoster Virüsü, suçiçeği enfeksiyonu, gebelik, konjenital suçiçeği sendromu, Aim: Chickenpox infection is an infectious disease characterized by itchy, maculopapular, vesicular, pustular rash and dry skin. It can cause morbidity during pregnancy. In this article, it is aimed to present the follow-up and treatment of the patient who started to show symptoms of VZV infection in the 19th week of pregnancy.Case: Our case was a 19-week pregnant woman. G2, P1 was 31 years old. The patient, who had vesicular and itchy lesions, was diagnosed with varicella due to characteristic lesions as a result of dermatology consultation. Antiviral therapy was started for varicella treatment. Microcephaly, extremity hypoplasia, and intrauterine growth retardation were not observed in obstetric ultrasonography. Birth occurred in the 37th week of follow-up. The newborn without any abnormality was discharged, and no abnormal findings were found in the post-discharge controls.Conclusion: Antenatal chickenpox infection is associated with serious complications for the mother and fetus. Oral acyclovir alone or in combination with VZIG may be beneficial as antiviral therapy for pregnant women with chickenpox infection.

Information regarding specific anatomic anomalies affords the physician the opportunity to offer the patient sophisticated prenatal procedures, such as fetal surgery or selective fetal reduction in multiple gestations. Likewise, prenatal knowledge about genetic, physiologic, and/or anatomic abnormalities enables the physician to tailor or manage the timing and mode of delivery for optimal maternal and fetal outcomes. Prenatal diagnosis also allows the neonatal and paediatric specialists to be adequately prepared for a potentially ill neonate at delivery. Recent progress in the fields of maternal fetal medicine, radiology, and genetics has resulted in great advances in prenatal diagnosis. Ultrasonography is the initial modality for evaluation of pregnant patient because of its widespread availability and reasonable cost, with other modalities used only if Ultrasonography results are non diagnostic. Hence based on above data the present study was planned Study of Congenital Fetal anomalies with the Help of Sonographic Evaluation. The present study was planned in Department of Radio- Diagnosis, Katihar Medical College and Hospital, Katihar, Bihar, India. All pregnant females of second trimester who are referred from obstetrics and gynaecology department and thus sent to department of Radio diagnosis for antenatal Sonographic examination. A complete antenatal ultrasound examination of pregnant women included in the study will be done using gray scale & colour duplex examination. Obstetric ultrasonography has become an important part of routine antenatal care. Routine anomaly screening improves perinatal outcome directly through termination of pregnancy for certain anomalies. Congenital fetal anomalies are one of the most threatening complications which are prevalent in the society associated with severe morbidity and mortality in the new born fetus or neonates. Ultrasound is the best possible non-invasive technique available to detect any congenital anomalies in pregnant women which will help to identify the severity of the disease, its outcome leading to pregnancy termination or gives an opportunity for fetal therapy or better neonatal care. Keywords: Congenital Fetal anomalies, Sonography, etc.

WOS: 000456192300008, Background: The placenta is a soft organ with vital importance. Increased placental stiffness was reported in pathological conditions emerging during pregnancy, such as diabetes mellitus and hypertension. Nowadays, placental stiffness can be quantitatively measured using the shear wave elastography (SWE) technique. Objectives: We aimed to assess the factors affecting elasticity by finding the normal elastogram values of healthy pregnancy placentas using the SWE technique due to the importance of early diagnosis in risky pregnancies. Patients and Methods: In total, 288 healthy pregnant women in the second or third trimester were included in our prospective study. The pregnant women who had pathology in their fetus and its appendices or a posteriorly located placenta were excluded from the study. Obstetric ultrasonography and a placental elasticity assessment were performed in all the pregnant women. Speed values were obtained from five different locations of the placenta, including the central S1, S2, S3, S4 and peripheral P regions. The elasticity of the regions were compared, and the factors affecting elasticity were investigated. Results: There were significant differences among the velocity values obtained from five different areas of the placenta. The mean velocityvalues obtained from the central region were higher than those of the peripheral region (P < 0.001). There was also a significant difference in the mean velocity measurements obtained from the central region (P < 0.001). The hardest region of the placenta was the maternal surface, while the softest region was the peripheral surface. The elastographic velocityvalues of the placenta were found to correlate with maternal age, body mass index, placental localization, thickness, and grade, whereas it did not correlate with gravidity, parity, gestational week, and amniotic fluid index. Conclusion: The elasticity of the placenta varied according to the region and surface, whereas it did not change according to gestational week. It may be convenient to use the elasticity values obtained by SWE from specified regions in the follow-up of placentas in high-risk pregnancies. However, considering the affecting factors and contradictory study results, a large number of large-scale studies is required to strengthen the efficiency of SWE in the placental assessment.

Objective To evaluate fetal cardiac ventricular disproportion as a marker of cardiac anomalies. Methods A retrospective case series included data from all patients who had a fetus diagnosed subjectively with ventricular disproportion by routine obstetric ultrasonography between January 1, 2007 and December 31, 2013 at a single tertiary center in the USA. Fetal and neonatal echocardiography, and neonatal outcome data were retrieved. Outcomes were described for all fetuses with subjective ventricular disproportion. Then, the objective right-to-left ventricular ratio (RLVR) was calculated as a continuous (after transformation to gestational age specific z-scores) or categorical value (> 2SD for gestational week), based on previously published reference values. Subsequently, correlations between the objective RLVR and neonatal outcomes were evaluated. Results Records from 60 fetuses diagnosed with ventricular disproportion at 16–38 weeks of gestation were included. These pregnancies resulted in 54 live deliveries; postnatally, 20 (37%) of these neonates were diagnosed with aortic coarctation and 39 (72%) were diagnosed with other cardiac anomalies, with or without aortic coarctation. No significant differences in objective prenatal diagnostic findings (RLVR) were demonstrated between neonates who were diagnosed postnatally with aortic coarctation or any cardiac anomaly and those not. Conclusion Subjective ventricular disproportion, regardless of objective diagnosis, was associated with cardiac defects. The use of fetal and neonatal echocardiography following diagnosis of fetal ventricular disproportion appears justified.

To assess levels of awareness and use of obstetric ultrasonography in rural Nepal.Between March 2014 and March 2015, a cross-sectional survey was conducted among married women aged 15-40years residing in rural Sarlahi District, Nepal, regarding their knowledge and use of obstetric ultrasonography during their most recent pregnancy. Regression analyses were conducted to identify reproductive health, socioeconomic, and other characteristics that increased the likelihood of undergoing an obstetric ultrasonographic examination.Among 6182 women, 1630 (26.4%) had undergone obstetric ultrasonography during their most recent pregnancy, of whom 1011 (62.0%) received only one examination. Odds of receiving an ultrasonographic examination were higher among women with post-secondary education than among those with none (≥11years' education: adjusted odds ratio [aOR] 10.28, 95% confidence interval [CI] 5.55-19.04), and among women whose husbands had post-secondary education than among those with husbands with none (≥11years' education: aOR 1.99, 95% CI 1.47-2.69). Odds were lower among women younger than 18years than among those aged 18-34years (aOR 0.72, 95% confidence interval 0.59-0.90).Utilization of obstetric ultrasonography in rural Nepal was very limited. Further research is necessary to assess the potential health impact of obstetric ultrasonography in low-resource settings, while addressing limitations such as cost and misuse.

Objetivo: Relatar um caso de sepse em gestação pré-termo, ocorrido em um hospital de ensino e pesquisa, referência no atendimento à gestante de alto risco, no Estado do Pará. Detalhamento do caso: Paciente do sexo feminino, 26 anos, primigesta, portadora de Artrite Reumatoide, com Idade Gestacional de 32 semanas e 3 dias com queixa de lombalgia e dor em baixo ventre. O quadro evoluiu com polaciúria, Giordano positivo a direita, colo entreaberto e perda do tampão mucoso. No segundo dia de internação a paciente apresentou taquicardia e após a realização da ultrassonografia obstétrica foi constatado a morte fetal intrauterina. Após avaliação, e posterior piora do quadro, foi prescrito novo de antibiótico e mudança para leito em unidade de terapia intensiva, assim como a realização da interrupção cirúrgica da gravidez. Considerações finais: Visto à rápida evolução do quadro de sepse, e ao difícil diagnóstico do quadro devido as mudanças fisiológicas da gravidez, ressalta-se a importância da agilização diagnóstica e pronta instituição terapêutica, a fim de se evitar as principais complicações do quadro, como mortalidade materno-fetal e prematuridade.

IntroductionDisorders of fetal growth, such as intrauterine growth restriction (IUGR) and large for gestational age (LGA), have been found to have a profound effect on the development of the fetal kidney. Abnormal kidney development is associated with hypertension and chronic kidney disease later in life. This study will use a novel ultrasound measurement to assess the renal parenchymal growth and kidney arterial blood flow in the fetus to evaluate the development of the fetal kidneys and provide an indirect estimate of nephron number. Measurements in normally grown, IUGR and LGA fetuses will be compared to determine if changes in renal parenchymal growth can be detected in utero.Methods and analysisThis longitudinal, prospective, observational study will be conducted over 12 months in the Ultrasound Department of the Townsville Hospital, Australia. The study will compare fetal renal parenchymal thickness (RPT) and renal artery Doppler flow between IUGR fetuses and appropriately grown fetuses, and LGA fetuses and appropriately grown fetuses between 16 and 40 weeks. The fetal RPT to renal volume ratio will also be compared, and correlations between RPT, renal parenchymal echogenicity, fetal Doppler indices and amniotic fluid levels will be analysed.Ethics and disseminationThis study was approved by the Townsville Health District Human Research Ethics Committee. The study results will form part of a thesis and will be published in peer-reviewed journals and disseminated at international conferences.

Objectives The purpose of this study was to investigate the efficacy and safety of temporary prophylactic intravascular balloon occlusion of the common iliac arteries (CIA) before planned cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Materials and methods A retrospective study of 13 pregnant women at risk for placenta accreta identified using sequential obstetric ultrasonography and magnetic resonance imaging from January 2007 to December 2009 was performed. Temporary prophylactic intravascular balloon catheterization of the bilateral CIA before cesarean hysterectomy was performed by interventional radiologists. The maximum duration of occlusion time of CIA must not exceed 60 minutes. The primary outcome for this study included estimated blood loss and secondary outcomes included the development of thromboembolism, disseminated intravascular coagulation and surgical complications. Results Among these13 patients, the mean age of the patients was 32.8 ± 0.7 years (range 29–37 years). The mean gestational age at cesarean hysterectomy was 32.2 ± 0.9 weeks (range 28–36 weeks), and the mean intraoperative blood loss was 1902.3 ± 578.8 mL (range 500–8000 mL). Operative bleeding was controlled by conservative treatment without additional surgery in two cases. Importantly, two patients (15.8%) had severe complications possibly related to the interventional procedure. One patient was noted to have a popliteal artery thrombosis. A second patient had an external iliac artery thrombosis with 80–90% occlusion. Both patients required antithrombotic treatment without sequelae. Conclusion With limited experience in this small series, we observed a statistically significant reduction in operative blood loss after the use of temporary prophylactic balloon occlusion of the CIA technique compared with historical controls of similar demographic characteristics previously published (1902.3 ± 578.8 mL, range 500–8000 mL vs. 4445.7 ± 996.48 mL, range 1040–15,000 mL, p = 0.0402). Additionally, two patients had arterial thrombosis. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness and safety of this new technique.

Gebelikte uterus rüptürü, fetal ve maternal mortalite insidansının yüksek olduğu nadir rastlanan fakat gerçekleştiğinde sıklıkla katastrofik seyreden bir komplikasyondur. Kırk yaşında, 33-34 hafta gravida 2 partus 1 olan gebe hasta 6 saattir var olan bulantı, kusma, şiddetli karın ağrısı şikayetleriyle kliniğimize başvurdu. Özgeçmişinde, 2 yıl önce kliniğimizde robotik cerrahiyle myomektomi öyküsü vardı. Yapılan obstetrik ultrasonografide 33 haftalık kalp atımları izlenmeyen fetüs izlendi. Bunun üzerine hasta acilen laparotomiye alındı ve uterus ön duvarında 4 cm'lik rüptür alanı izlendi. Uterus rüptürü, özellikle uterin cerrahi öyküsü olan hastalarda akılda tutulması gereken klinik bir durumdur, Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. A gravida 2 para 1 woman aged 40 years who was 33-34 weeks pregnant presented to our clinic with serious abdominal pain, nausea and vomiting that had begun 6 hours previously. Her past surgical history included a robotic myomectomy 2 years ago in our unit. Obstetric ultrasonography revealed a 33-week fetus without a heartbeat whereupon she underwent emergency laparotomy and we found a 4 cm rupture on the anterior wall of the uterus. Uterine rupture should always be kept in mind, especially in patients with history of uterine surgery

Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.

The two main measures used in the reduction of the birth prevalence of CNS birth defects are (i) folic acid, FA, supplementation/food fortification for reproductively active women as the primary one, and (ii) timely screening/intrauterine diagnosis, and possibly termination of the affected pregnancies.We performed a cross-sectional survey of the levels of awareness and uptake of these measures in a consecutive cohort of mothers of children with CNS birth defects presenting for neurosurgical treatment in an African clinical practice.There were 151 cases, 101 of them neural tube defects, NTDs. The level of awareness of the role of FA in prevention of these defects was low, 18.8%, and dietary multivitamin supplementation was ingested by only10.7% of the study subjects. The mothers' obstetric behavior in the index pregnancies was suboptimal: pregnancy registration and commencement of obstetric supplements were at median gestational age of 4 months, and obstetric ultrasonography was obtained infrequently, and in an unregulated milieu. Only 17.8% of these CNS birth defects were diagnosed prenatally, but80% of the mothers would have liked to have the intrauterine diagnosis, and about 23% might have asked for termination of these pregnancies.The levels of awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in this sub-Saharan African women cohort are low. Interestingly, many of the mothers were very favorably disposed to receiving, and acting on, the information about the screen detected CNS birth defects in their fetuses.

During the last decades – mainly since the introduction of obstetric ultrasonography – prenatal care in most industrialized countries has evolved from a mother-targeted paramedical discipline to fe...

OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother’s last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

Craniofacial deformities have a high psychosocial impact. The aim of this paper is to improve obstetric ultrasonography and prenatal detection of facial anomalies by providing a new fetal dental panorama. The present study describes a new modality to visualize the fetal tooth germs and an easy step-by-step diagnostic approach. Image acquisition was performed between 23 and 32 weeks of gestation using a Voluson E10 GE ultrasound machine with an RM6C transducer (GE Medical Systems, Zipf, Austria). Reconstruction was performed using Omniview from the axial image. Volume contrast imaging (VCI) was used with a thickness of 20 mm, and a render mode that combined “Rx mode” and “surface texture.” The resulting imaging allows a more precise visualization of the fetal dental arch and can be obtained between 14 and 28 weeks of gestation. The presence of dental anomalies can be a clue for the diagnosis of various congenital defects, in particular conditions with a shortage of other physical abnormalities, such as ectodermal dysplasia and Binder syndrome. The creation of a precise fetal dental panorama allows an improved detection of facial deformities. With the current paper, we want to increase prenatal diagnostics facial anomalies, and help to establish a tailored multidisciplinary treatment plan. This paper should be of interest to readers who are currently treating patients with craniofacial malformations and readers who are performing diagnostic prenatal sonography.

To investigate previously un-identified risk factors for the progression of gestational hypertension (GH) to pre-eclampsia (PE) by considering Grade III preterm placental calcification (PPC) and excessive weight gain (≧10kgw) at 28weeks gestation.At a tertiary teaching hospital, obstetric ultrasonography was performed at 28weeks gestation to establish a diagnosis of grade III PPC. Weight gain during pregnancy was recorded at the same time. Pregnancies complicated with chronic hypertension, major fetal congenital anomalies, termination before 24weeks gestation, and abortion before 20 weeks gestation were excluded.In the current cohort study, 20,103 pregnancies were enrolled and categorized as normal blood pressure (NBP; n=18,223) and GH-PE (n=1880) groups. According to severity of the diseases, the GH-PE group was further divided into GH (n=1088), PE (n=792), and severe PE (n=209) groups. There were significant differences between the NBP and GH-PE groups in known factors, including maternal age, BMI, parity, multi-fetal pregnancy, and co-morbidities (all p0.001), all of which increased the risk for GH-PE. Regarding the progression of GH to PE and severe PE, there was a much greater frequency of excessive weight gain (51.2% and 49.0% vs. 9.3%) or PPC (63.2% and 61.6% vs. 12.1%) in the severe PE and PE groups than the GH group. Logistic regression analysis revealed that PPC was a significant and independent risk factor for progression of GH to PE (OR, 13.71; 95% CI, 10.25-18.33) and severe PE (OR, 12.42; 95% CI, 8.89-17.35), as well as excessive weight gain during pregnancy (OR, 8.92; 95% CI, 6.67-11.92 and OR, 10.25; 95% CI, 7.30-12.40).Being a pathologic implication, the presence of PPC or excessive weight gain during pregnancy may precede progression of GH, and can serve as a warning or marker that requires closer surveillance for maternal and fetal well-being. Based on the findings of PPC and excessive weight gain, at-risk pregnant woman should be counseled to facilitate early intervention or referral. In addition, avoiding excessive weight gain during pregnancy may reduce the risk of GH progression to PE.

Purpose To determine the role of ultrasound imaging in evaluating fetal kidney growth. Methods MEDLINE, CINAHL and EMBASE databases were electronically searched for studies between 1996 and January 2017 and limited to English language. Studies were included if they reported on an ultrasound technique to assess fetal kidney growth and they were not a case report or case series. There was independent selection of studies by two reviewers in consensus with one other reviewer. Data were extracted by one reviewer in consensus with two other reviewers. Results A total of 1785 articles were identified. The full text of 39 of these were assessed for eligibility for inclusion. Twenty-eight studies were then included in the review. Standard two dimensional (2D) fetal renal measurements are easy to perform, however, this review identified that most studies had some methodological limitations. The disadvantage with 2D and three dimensional (3D) fetal renal volumes are that they include the entire kidney and good reproducibility of 3D volumes has not yet been demonstrated. Currently there is limited research on fetal kidney growth in the setting of abnormal fetal growth. Research focussing directly on fetal kidney parenchyma and blood flow is scarce. Conclusions Some nomograms of 2D and 3D fetal kidney size and volume have been developed. Kidney length is the most popular single fetal kidney measurement; however, it does not seem to be a good indicator of growth. In IUGR fetuses, kidney length remained similar to appropriately grown fetuses whereas AP and TS dimensions were significantly decreased. New ultrasound techniques focusing on the parenchyma of the kidney and perfusion to the kidney should be explored as they may provide more meaningful information on kidney development in the fetus and future kidney function.

Background Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy. Technique Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units. Experience Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema. Findings expedited diagnosis and treatment in both cases. Conclusion Lung ultrasonography has potential to be used in obstetrics for detecting pulmonary edema in preeclampsia. It is a well-established tool in critical care settings and use in obstetric patients should be studied given the availability of ultrasonography on labor and delivery and the importance of timely care for critically ill pregnant patients. It is a safe modality to evaluate pregnant women with respiratory symptoms and the necessary skills can be easily acquired by obstetric practitioners familiar with obstetric ultrasonography. Training of obstetric practitioners in this application of ultrasonography is needed.

INTRODUCTION: first trimester pregnancy is defined as twelve weeks after the last menstrual period. Ultrasonography has revolutionized validation and management of first trimester pregnancies. The aim was to analyze ultrasonographic findings of first trimester pregnancies in University of Uyo teaching hospital (UUTH), Uyo, Nigeria. METHODS: the departmental ultrasonographic records of pregnant women who were referred to Radiology department of UUTH, Uyo, Nigeria. For ultrasound scans were retrospectively reviewed. The period under consideration was from 8th January 2013 to 8th February, 2016. Demographic data and ultrasonographic parameters of first trimester pregnancies like gestational sacs were recorded. Data were statistically analyzed using SPSS Chicago 13. Exclusion criterion included incomplete data and acyesis despite positive ² hCG test. RESULTS: 26.4% (n-645) of the 2438 pregnant women who underwent obstetric ultrasonography had first trimester ultrasonography during the studied period. The peak frequency was seen in the 20-29 age range with 52.2% (n-337) and followed by 30-39 age range with 41.7% (n-269). The commonest first trimester ultrasound findings was viable pregnancy with 42.5% (n-274), followed by incomplete miscarriage with 34.3% (n-221). The least finding was trophoblastic pregnancies 0.3% (n-2). The earliest age at which normal viable pregnancy was diagnosed in this study was 5weeks 5days from the last menstrual period. Only 2.19% (n-6) of the normal viable pregnancies were multiple pregnancies and they were all twins. The highest number of referrals to Radiology Department for first trimester ultrasonography was from accident and emergency unit with 34.42% (n-222) while antenatal clinic referral was only 16.12% (n-104). CONCLUSION: the commonest first trimester’s obstetric ultrasonographic findings in Uyo, Nigeria are viable pregnancies and are predominantly single gestation. The earliest age of ultasonographic pregnancy detection in Uyo is 5week 5days and peak maternal age is second and third decades.

Objective To estimate the association between uterine fibroids and adverse obstetric outcomes. Methods This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Results Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7–2.0), breech presentation (AOR 1.3, 95% CI 1.2–1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1–1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P

Introduction: Fetal biometry is a methodology devoted to measuring several parts of fetal anatomy and their growth. Aim: The present study was carried out to assess gestational age in the second and third trimesters with the help of ultrasonographic measurements of four fetal biometric parameters (i.e., biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL]) in the local population (Jaipur Zone) of Rajasthan, and also to evaluate efficacy and significance of these four fetal biometric parameters in the prediction of gestational age by ultrasound. Materials and methods: Three hundred and thirty cases of normal pregnant females were studied (165 - second trimester [13–28 weeks] and 165 - third trimester [29–40 weeks]) with the known last menstrual period (LMP) and studied once during gestation. Results: Biparietal diameter and head circumference were found to be equally best predictors of gestational age and to determine the expected date of delivery (EDD) in the second trimester and BPD and FL in the third trimester. Abdominal circumference was the least accurate parameter in both trimesters. Variability in predicting gestational age (using all four parameters) was ±2 weeks in the second trimester and +2 to −4 weeks in the third trimester. The accuracy decreased and variability increased as the pregnancy advanced from the second to third trimester. Mean measurements of fetal biometric parameters were found lower than Western monograms in each week of both trimesters. Conclusions: Variation in predicted gestational age by ultrasonography (USG) is attributed to the anthropometric difference between the two populations due to racial, genetic, nutritional, and socioeconomic factors. Therefore, population-specific measurements should be made to generate tables and regression equations for more precise reporting of gestational age and EDD by USG.

Fetal magnetic resonance (MR) imaging plays an increasing and valuable role in antenatal diagnosis and perinatal management of fetal gastrointestinal (GI) abnormalities. Advances in MR imaging data acquisition and use of motion-insensitive techniques have established MR imaging as an important adjunct to obstetric ultrasonography (US) for fetal diagnosis. In this regard, MR imaging provides high diagnostic accuracy for antenatal diagnosis of common and uncommon GI pathologic conditions. In the setting of fetal GI disease, T1-weighted images demonstrate the amount and distribution of meconium, which is crucial to the diagnostic capability of fetal MR imaging. Specifically, knowledge of the T1 signal intensity characteristics of fetal meconium, the normal pattern of meconium with advancing gestational age, and the expected caliber of small and large bowel in the fetus is key to diagnosis of abnormalities of the GI tract. Use of ultrafast T2-weighted sequences for evaluation of the expected location and morphology of fluid-containing structures, including the stomach and small bowel, in the fetal abdomen further aids in diagnostic confidence. Uncommonly encountered fetal GI pathologic conditions, especially cloacal dysmorphology, may demonstrate characteristic MR imaging patterns, which may add additional information to that from fetal US, allowing improved fetal and neonatal management. This article discusses common indications for fetal MR imaging of the GI tract, imaging protocols for fetal GI MR imaging, the normal appearance of the fetal GI tract with advancing gestational age, and the imaging appearances of common fetal GI abnormalities, as well as uncommon fetal GI conditions with characteristic appearances. (©)RSNA, 2016.

We sought to compare perinatal outcomes between women with and without leiomyomata.This is a retrospective cohort study comparing neonatal outcomes in women with and without uterine leiomyomata discovered at routine second trimester obstetric ultrasonography, all of whom delivered at a single institution. Potential confounders such as maternal age, parity, race, ethnicity, medical insurance, previous uterine surgery, fetal presentation, length of labor, mode of delivery, presence of placenta previa, placental abruption, chorioamnionitis, and epidural use were controlled for using multivariable logistic regression.From 1993 to 2003, 15,104 women underwent routine second trimester prenatal ultrasonography, with 401 (2.7%) women identified with at least one leiomyoma. By univariate and multivariable analyses, the presence of leiomyomata was associated with statistically significant increased risks for preterm delivery at34 weeks [adjusted odds ratio (AOR) 1.7, 95% confidence interval (CI) 1.1-2.6],32 weeks (AOR 1.9, 95% CI 1.2-3.2), and28 weeks (AOR 2.0, 95% CI 1.1-3.8). An association with increased risk for intrauterine fetal demise (IUFD) was also demonstrated (AOR 2.7, 95% CI 1.0-6.9). When IUFD was examined before and after 32 weeks' gestation, the finding only persisted at earlier gestational ages (32 weeks: AOR 4.2, 95% CI 1.2-14.7 vs.32 weeks: AOR 0.82, 95% CI 0.1-6.2).Regardless of maternal age, ethnicity, and parity, pregnant women with leiomyomata are at increased risk for preterm birth and IUFD. This did not translate to lower birth weight outcomes among term patients, suggesting that LBW is more likely due to preterm birth than growth restriction. These results may be useful for preconception and prenatal counseling of women with leiomyomata.

Contents Obstetric ultrasonography is the most common diagnostic approach used in veterinary reproduction because it is a simple, reliable and non-invasive imaging technique. With advances in ultrasonography of small ruminants, assessment of pregnancy in goats is challenging for accurately managing reproduction. This article presents an up-to-date review of the use of ultrasonography in pregnancy for the diagnosis and evaluation of intrauterine foetal growth in goats.

Objectives. To establish a curve of amniotic fluid index [AFI] measurements from the 20th to the 42nd week of pregnancy. Methods. A prospective and descriptive study was performed, in which an independent sample of 2,868 low-risk pregnant women were studied using routine ultrasound, including fetal biometry and measurement of AFI. Data were analysed using multiple linear regression, and constructing a curve using 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI measurements, according to gestational age, and after submitting values to smoothing process using quadratic polynomial adjustment. Results. There was a significant variation in AFI measurements at the different gestational ages. The 50th percentile remained practically constant at approximately 150 mm between the 20th and 33rd week, after which there was a decline in volume, which became evident after the 38th week. At the 40th week, the 10th percentile was around 62 mm and the 2.5th percentile around 33 mm. Conclusions. The curve of percentiles of AFI measurements in low-risk pregnant women showed significant decrease with gestational age, especially after the 33rd week. These data should be validated for a diagnosis of increased or decreased volumes of amniotic fluid at specific gestational ages.

Stillbirth is an important issue in antenatal care and much remains unknown. This cohort study aims to explore the previously un-identified risk factor of third-trimester stillbirth to determine if Grade III preterm placental calcification (PPC) is associated with stillbirth.At a tertiary teaching hospital, obstetric ultrasonography was performed at 28 weeks' gestation to establish a diagnosis of PPC. Pregnancies with multifetal gestations, major fetal congenital anomalies, termination, cord accidents, apparent intrauterine infection, and antepartum complications were excluded.15,122 eligible pregnancies were categorized as stillbirth (n = 99) and livebirth (n = 15,023) groups. Between these two groups, there were no significant differences in maternal age, BMI, and parity, but significant differences in smoking and in PPC (35.4% vs 6.3%, p 0.001) were observed. The peak occurrence of stillbirths was at 30 and 37 weeks' gestation, with a bimodal distribution of 11 and 17 stillbirths, respectively. For pregnancies with or without PPC, the incidences of stillbirths per-1000-births were 35.9 and 4.5, respectively. Using Kaplan-Meier survival analysis, at 40 weeks' gestation the cumulative stillbirth risk for pregnancies with PPC was higher compared to those without PPC. Logistic regression revealed that after adjusting for the effects of smoking and demographic factors, the risk of stillbirth (adjusted OR:7.62; 95% CI:5.00-11.62) was much higher when PPC was present.Grade III PPC is associated with a higher incidence of stillbirth, and identified an independent risk factor. Being a pathologic implication, it may precede this negative outcome and can serve as a warning sign or marker when noted on ultrasonography.

Objective To examine the association between leiomyomata and complications during pregnancy, delivery, and the puerperium. Methods We conducted a retrospective cohort study comparing pregnancy outcomes in women with and without uterine leiomyomata who underwent routine second trimester obstetric ultrasonography and delivered viable infants at a single institution. Potential confounding variables, including maternal age, weight, ethnicity, parity, gestational age, epidural use, and labor induction, were controlled for using multivariate logistic regression techniques. Results From 1993 to 2003, 15,104 women underwent routine second trimester prenatal ultrasonography, and 401 (2.7%) women were identified with at least 1 leiomyoma. By univariate and multivariate analyses, the presence of leiomyomata was associated with increased risks for cesarean delivery (adjusted odds ratio [AOR] 1.57, 95% confidence interval [CI] 1.16-2.13), breech presentation (AOR 1.64, 95% CI 1.11-2.40), malposition (AOR 1.59, 95% CI 1.18-2.15), preterm delivery (AOR 1.45, 95% CI 1.08-1.96), placenta previa (AOR 1.86, 95% CI 1.02-3.39), and severe postpartum hemorrhage (AOR 2.57, 95% CI 1.54-4.27). Premature rupture of membranes, operative vaginal delivery, chorioamnionitis, and endomyometritis were not associated with leiomyomata. Median length of labor was not different between the 2 groups. When compared with leiomyomata less than 10 cm in size, leiomyomata 10 cm or larger were associated with rates of cesarean delivery that were not statistically different (25% compared with 31%, P = .49). Conclusion Pregnant women with leiomyomata are at increased risk for cesarean delivery, breech presentation, malposition, preterm delivery, placenta previa, and severe post partum hemorrhage. Women with leiomyomata 10 cm or larger achieve a vaginal delivery rate of nearly 70%. These results are useful for preconception and prenatal counseling of women with leiomyomata. Level of evidence II-2.

In the past eight years magnetic resonance imaging has been used to detect fetal abnormalities in utero at many centres around the world. An increasing number of published papers have shown improved diagnostic accuracy with in utero magnetic resonance imaging compared with obstetric ultrasonography, the current reference standard. This is particularly so in cases of brain and spine abnormalities in the fetus, and much of the published work has concentrated on those anatomical regions. When a new application for an existing technology is discovered, there is a delicate balance between assessing the method adequately in a research environment and the desire to introduce it into the clinical arena as soon as possible. Here we describe the current status of in utero magnetic resonance imaging and outline some of the ethical issues raised by working with a new application in this complicated clinical environment. The fictional case we outline is a composite story of circumstances we found ourselves in soon after we started our research programme on in utero magnetic resonance imaging in 1999. Our situation was helped by foresight and by discussing it prospectively with the local research ethics committee. We have used this scenario to introduce the topic of in utero magnetic resonance imaging, to show its potential benefits, and to outline the practical and ethical issues that are raised by using the technique. The obstetrics and radiology departments of a teaching hospital decide to carry out clinical in utero magnetic resonance imaging in some pregnant women whose fetuses have developmental brain problems diagnosed by ultrasonography. The first case attempted is technically successful, but the agenesis of the corpus callosum and Dandy-Walker malformation detected by ultrasonography cannot be confirmed by in utero magnetic resonance imaging. The brain seems to be normal. The woman had decided to terminate the fetus …

Objective. The aim of this study was to determine the quality of antenatal care and the role of routine obstetric ultrasonography (US) in Turkey's antenatal care program. Materials and method. Two surveys consisting of 11 questions were conducted on 295 patients without pregnancy associated risk in 1995 and on 208 patients in 2000, during the first 24 h after delivery. The results of the two surveys were compared. A P value of

Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. It has a benign prognosis, but it is very important not to misdiagnose it as a cephalocele, which carries a guarded prognosis. We present the case of a patient who experienced preterm labor and premature rupture of the membranes at 28 weeks' menstrual age. Our initial diagnosis was cephalocele, but after the male infant was delivered by cesarean section, examination revealed no bone defect, and our final diagnosis was caput succedaneum. We also discuss the sonographic findings and diagnostic differences between caput succedaneum, cephalocele, and other fetal head masses.

Bu yazıda, sol atriyum izomerizmi, heterotaksi sendromu ve tam kalp bloğu olan Meckel-Gruber sendrom’lu (MKS) bir fetüs sunuldu. Yirmi altı yaşındaki sağlıklı anne gebeliğinin 23. haftasında kliniğimize başvurdu. Fetüsün kalbi de içeren çok sayıda sistemik anomalisi vardı. Fötal ekokardiyografide horizontal karaciğer, sol yerleşimli mide ve azigos devamlılığı olan kesintili kaval veni vardı. Ayrıca apikal trabeküler ventriküler septal defekt, sol ventrikülden çıkan aorta ve pulmoner arter, pulmoner arter hipoplazisi, pulmoner kapak stenozu ve sol atriyum izomerizmi mevcuttu. Kalp hızı 46/dk idi ve üçüncü derece kalp bloğu ile uyumlu idi. Obstetrik ultrasonografisinde oksipital ensefalosel, iki taraflı polikistik böbrekler, yarık dudak, yarık damak ve polidaktiliyi içeren çok sayıda anomali saptandı. Perinatoloji konseyi kararı ile 23. gebelik haftasında gebelik sonlandırıldı. Otopsi incelemesi sol atriyum izomerizmi heterotaksi sendromu ve MKS tanısını doğruladı. Meckel-Gruber sendromlu fetüslerde daha önce birtakım kardiyak defektler bildirilmiş ise de, biz burada sol atriyum izomerizmi ve heterotaksi sendromunu da içeren MKS ile ilişkili kardiyak anomaliler spektrumunu genişletmiş olduk., We aimed to present a fetus with Meckel-Gruber syndrome (MKS) who had left atrial isomerism, heterotaxy syndrome and complete heart block. A 26-year-old healthy female was referred to our clinic in the 23rd week of her preg- nancy. the fetus had multiple systemic anomalies including fetal heart. Fetal echocardiography revealed a horizontal liv- er, left-sided stomach and vena cava interruption with azygos continuation. There was also an apical trabecular ventricular septal defect, aorta and pulmonary artery arising from the left ventricle, pulmonary artery hypoplasia, pulmonary valve stenosis and left atrial isomerism. the heart rate was 46/min, consistent with third-degree atrioventricular block. Multiple anomalies including occipital encephalocele, bilateral poly- cystic kidneys, cleft lip, cleft palate, and polydactyly were also detected in the obstetric ultrasonography. the pregnan- cy was terminated in the 23rd gestational week based on the consensus of perinatology council. the autopsy examination confirmed the diagnosis of MKS, left atrial isomerism and heterotaxy syndrome. Although some cardiac defects have been reported previously in MKS fetuses, here we expand the cardiac spectrum of anomalies associated with MKS to include left atrial isomerism and heterotaxy syndrome.

Objective. To determine the efficacy of obstetric ultrasonography in the detection of fetal cleft lip. Methods. The study population included all women who had a fetal anatomic survey with adequate visualization of the face and who gave birth at Brigham and Women's Hospital between January 1, 1990, and January 31, 2000. All neonates born with cleft lip were identified from the Brigham and Women's Active Malformation Surveillance Program. Confirmation of the anatomic defect was obtained from the pediatric record or from the pathologic report if the pregnancy was terminated or ended in miscarriage. Cases of isolated cleft palate were excluded. An ultrasonography database was used to identify all cases of cleft lip diagnosed before delivery. Maternal information regarding the pregnancy was abstracted from the medical record. Statistical significance was determined using the x 2 statistic for categorical variables and the t test for continuous variables. Results. A total of 56 confirmed cases of cleft lip were identified in the study population. Overall, 73% of the cases (41 of 56) were identified antenatally. Additional fetal anomalies were present in 54% of the cases (30 of 56). A comparison between those cases that were detected and those in which the diagnosis was missed showed that there was a significantly lower detection rate if the ultrasonography was performed before 20 weeks (12 [57%] of 21 versus 29 [83%] of 35; P = .035). There was no difference between the 2 groups in terms of maternal age or weight. Maternal parity, prior maternal abdominal surgery, the presence of a multiple gestation, or coexisting fetal anomalies did not significantly affect the detection rate. There was no difference in detection rate in the first half of the study period (1990-1995; 23 [72%] of 32) compared with the second half (1996-2000; 18 [76%] of 24; P = .79). Conclusions. In this cohort of women, the rate of detection of fetal cleft lip was significantly lower when the anatomic survey was performed before 20 weeks' gestation This difference could not be accounted for by such variables as prior maternal abdominal surgery, coexisting fetal anomalies, or improvements in ultrasonographic detection with time. We recommend that the anatomic survey for fetuses at high risk for this condition be performed after 20 weeks' gestation. .

ltrasonographic screening in pregnancy has been and continues to be a matter of controversy. For the past 20 years, second-trimester ultrasonographic screening has been debated. Even today, the American College of Obstetricians and Gynecologists does not endorse this as a standard of care. Nonetheless, secondtrimester ultrasonography is widely offered. In 1989, two of us (F.A.C. and L.B.M.) made the argument that “the standard of care demands that prenatal informed consent for sonogram be accepted as an indication for the prudent use of obstetric ultrasonography performed by qualified personnel.”1 The purpose of this editorial is to extend that argument to first-trimester ultrasonographic screening for aneuploidy using nuchal translucency determination.

Purpose: The nasal bone is one of the important fetal structures to be radiologically evaluated in the first and second trimesters. In this study, we aimed to evaluate the nasal root and to determine the normal range of the naso-frontal angle, which may potentially be used as a predictive or diagnostic parameter in the diagnosis of the above-mentioned syndromes or other congenital abnormalities with associated nasal features using obstetric ultrasonography in normal fetuses. Methods: We evaluated the naso-frontal angle using transabdominal ultrasonography in 195 healthy fetuses between the 18th and 21st weeks of gestation. The measurements were performed with the fetal neck in mild flexion and three echogenic lines (nasal end, skin on the nasal bone, nasal bone) visualized. Results: The minimum, maximum and mean naso-frontal angle values were 110°, 143° and 128°, respectively, between the 18th and 21st weeks of gestation. Linear regression analysis showed no association between NFA and gestational week (Beta = 0.020 p = 0.786). Conclusions: The normal range of NFA between the 18th and 21st weeks of gestation was determined in this study. The association between NFA measurements and various congenital anomalies or fetal outcomes remains to be investigated. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2011

Background/Purpose : Screening programs using urinary vanillylmandelic acid have detected neuroblastomas in early infancy with some success. With the widespread use of ultrasonography in modern obstetric practice, use of ultrasonography to screen for fetal neuroblastoma seems to be reasonable and practical. Methods : Seven fetuses had suprarenal masses detected by maternal ultrasound scan at 32 to 37 weeks' gestation between 1993 and 1998. They were delivered normally if the pregnancy was uncomplicated, especially if it was without maternal preeclampsia or fetal hydrops. Each mass was further confirmed by ultrasound scan, computed tomography, or magnetic resonance imaging in the neonatal period. Tumor excision was performed at the age of 6 to 38 days of life. Results : The size of the masses measured ranged from 2.0 × 2.0 cm to 4.5 × 4.5 cm. The diagnosis was adrenal hemorrhage in 1 neonate, Evan's stage I neuroblastoma in 3, and stage IV-S neuroblastoma in 3. All of the specimens with a diagnosis of neuroblastoma showed a favorable histology by the Shimada classification system. Infants with stage I disease were treated with tumor excision only, and they had survived without disease by 14, 18, and 25 months of follow-up. One infant with stage IV-S neuroblastoma was treated further with minimal chemotherapy and has survived without disease at the 66-month follow-up examination. Another child with stage IV-S neuroblastoma has survived with local recurrence and increasing liver metastasis and was still on chemotherapy at the 2-month follow-up examination. The third child with stage IV-S disease presented with massive hepatomegaly and bone marrow involvement, and disseminated intravascular coagulopathy had developed. The patient died on the 5th day of life without surgical intervention. Conclusions : The increasing use of obstetric ultrasonography has made the prenatal screening of neuroblastomas possible. The prognosis of infants with a suprarenal mass may be improved with this early detection and early surgical intervention.

Objectives To compare the spectrum of tetralogy of Fallot detected recently in fetal life with that in previous reports of prenatal and postnatal experience. Methods All cases of tetralogy of Fallot, including those with pulmonary atresia, diagnosed between 1998 and 2005 inclusive were identified. Additional data for the 129 cases were collected, including associated congenital heart malformations, nuchal translucency measurement, karyotype and outcome. Results The most common reason for referral was a suspicion of heart malformation at the routine obstetric ultrasonography scan and referrals increased during the study period. The mean gestational age at diagnosis was 20.6 weeks. The nuchal translucency measurement was above the 95th centile in 37 (47%) of the 78 fetuses in which it had been measured, and in 19/37 of the chromosomally normal fetuses. Of 112 fetuses with chromosomal analysis, 55 (49%) had anomalies, including 22q11 microdeletion in 15. There were additional extracardiac malformations in 65/129 cases (50%) and additional cardiac malformations in 73 (57%). In 70/129 (54%) cases, the parents chose termination of pregnancy. Overall survival to date in the continuing pregnancies is 77%. Conclusions Tetralogy of Fallot is increasingly recognized during routine fetal obstetric scanning. However, the spectrum of disease detected in the fetus remains biased towards those cases with extracardiac malformations and those with complex disease. As a result, even in the current era, the prognosis for the whole group of fetal cases under the diagnostic heading of tetralogy of Fallot continues to be much less favorable than would be expected of a postnatal series. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.