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Objectives: The integration of ultrasound into routine obstetric workup has transformed antenatal care in resource-poor and remote communities in Africa. The present study aims to investigate the utilization of obstetric ultrasound at a cottage hospital in suburban Nigeria. Material and Methods: This retrospective study was conducted at Obio Cottage Hospital, Port Harcourt, Rivers State, South-South Nigeria. Ethical approval was obtained before commencement of the study from the Health Research Ethics Committee of University of Calabar Teaching Hospital with reference number UCTH/HREC/33/533. Reports were retrieved from the records of the radiology unit of the study facility, and data including biometric data and radiological diagnosis were transferred to Microsoft Excel spreadsheet for data analysis. Simple proportions and percentages were used to analyze the data. All statistical analyses were conducted using Statistical Package for the Social Science version 21.0, IBM Inc., Chicago, Illinois, USA. Statistical significance was set at P ≤ 0.05. Results: The total ANC visits at Obio Cottage Hospital was 28,072, with 27% (7689) utilization of ultrasound scan. The mean age and range of parity of attendees were 32 ± 2.3 and 1–5, respectively. Of the total scans performed, 99.93% was routine, while 0.07% (5) was clinical-based (targeted). Normal findings were 7520 (97.8%) of antenatal scans recorded, while abnormal cases, multiple gestation, and uncertain diagnosis accounted for 121 (1.57%), 44 (0.57%), and 4 (0.06%), respectively. Conclusion: The present study has shown a considerable volume of obstetric ultrasound scan in this cottage hospital, albeit, with low utilization compared to the number of antenatal registration. Findings were mainly normal with minimal need for referral for advance care.

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, …

Objective: In the present study, for which reasons fetal cardiac evaluation was requested from our pediatric cardiology clinic, the effects of routine fetal cardiac evaluation in obstetric ultrasonography (USG) on the detection of congenital heart disease (CHD) and the distribution of intrauterine diagnosis of CHD according to pregnancy risk profiles were retrospectively analyzed. Materials and Methods: Fetal echocardiography reports which containing the nineteen-month period were retrospectively examined. We performed a fetal echocardiography for all pregnant women who were referred to pediatric cardiology clinic after detail obstetric USG screening. The pregnancies were categorized into two groups based on the risk of CHD: Low-risk and high-risk groups. Detected congenital cardiac structural malformations were classified as complex, moderate, and mild according to perinatal mortality risk. Results: Of the 736 pregnancies, 22 were twin, and fetal cardiac evaluation was performed in 758 fetuses. There were 341 (46.3%) pregnancies in the high-risk group and 395 (53.6%) pregnancies in the low-risk group. The most common reason for fetal cardiac evaluation request was inability to adequately visualize the fetal heart (36.1%), while suspected fetal cardiac abnormality was the second most common cause (21.3%). Number of fetuses detected with cardiac abnormalities was 80 (23.5%) among high-risk pregnancies, and 20 (5%) among low-risk pregnancies. The most common type of malformation was simple cardiac abnormalities (6%) followed by complex lesions (4.1%). The most common cardiac abnormality was ventricular septal defect comprised of 18 cases (2.4%) while the most common complex cardiac abnormality was pulmonary atresia (1.2%). The rate of consistency was 40.1% between obstetricians and pediatric cardiologist in terms of the diagnosis of the congenital cardiac malformations. Conclusion: Routine evaluation of the fetal heart by means of obstetric USG, including four chambers, outflow tracts’ and three vessel views, would allow for diagnosing congenital cardiac malformations to a large extent during the intrauterine period.

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: Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. Findings: Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had knowledge that obstetric screening should be done before 24 weeks gestation. Four out of ten of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening is concerned. The lack of basic obstetric ultrasound screening skills is a barrier to rolling out Point of Care Ultrasound (POCUS) screening services. However, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.

Background: Obstetric sonography is one of the prenatal tests offered to most pregnant women and an essential tool that helps health care providers to establish fetal condition and growth. The Objective: to assess the knowledge, attitudes, and practice about obstetric sonography among women at KAUH in Jeddah, Saudi Arabia. Method: A cross-sectional study was conducted during 2018-2019 among 367 women. It included all women that attend the OB/GYN outpatient clinic at KAUH in Jeddah. The data was collected through interviewing questionnaire. The questionnaire consisted of 5 items to assess their knowledge, attitude, practice, and sociodemographic characteristics. Data were entered into a Microsoft Excel 2014 sheet, and statistical analysis was performed using IBM SPSS Statistics. Result: The mean knowledge score about obstetric sonography was 13.9 ± 1.7, where 343 (93.0%) had good knowledge, and only 26 (7.0%) had poor knowledge. The result revealed that the third-fourths of the women 291 (78.9%) believed that obstetric sonography is safe, and 309 (83.8%) believed that obstetric sonography doesn’t lead to a congenital anomaly. There was a difference in the knowledge score regarding education level, occupation, monthly income, and those with higher education, those who worked, and those with higher monthly payment had a higher knowledge score. Also, there was a positive correlation between knowledge score and both gravidity and parity. Conclusion: Women’s knowledge, attitude, and practice about the purpose of the obstetric sonography were good. So, the primary health care providers should be advised to focusing more on providing health education on obstetric sonography to all pregnant women during their ANC visits.

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume and fetal zone enlargement on ultrasound and evaluate its efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume and fetal zone enlargement was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth.

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume, fetal zone enlargement and cervical length on ultrasound and compare their efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume, fetal zone enlargement and cervical length was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters and cervical length was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Cervical length was found to be the least important marker for predicting the preterm birth as having the least AUC as 0.209, sensitivity as 36.4 % and specificity as 76.1%. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth and is a better predictor than cervical length. Keywords: Preterm, Cervical length, Adrenal biometry.

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.

Cesarean scar ectopic pregnancy (SEP), a rare type of ectopic pregnancy, is the implantation of a gestational sac in the myometrium and fibrous tissues at the site of a previous uterine scar (mostly cesarean section scar). The condition can be catastrophic if not managed on time, leading to significant morbidity and mortality. Early diagnosis made by transvaginal ultrasonography and a high degree of suspicion for the probability of SEP in previous uterine surgery patients may help in the initiation and success of conservative treatment, prevention of complications, and preservation of fertility. We present here the analysis of 22 cases of SEP managed at our institute between 2013 to 2020. The mean gestational age at the time of diagnosis was 8.6±2.2 weeks. The majority of the women presented with either pain or bleeding, but few cases (7 cases) were asymptomatic and were diagnosed with SEP during routine obstetric ultrasonography. Out of these cases, a single case was admitted with shock due to uterine rupture. The mean serum β-hCG level was 29,543 mIU/ml (range, 2105-61590). Asymptomatic patients with low serum β-hCG levels(

Objective: To investigate the accuracy of fetal weight estimation made by the last prenatal ultrasound measurement in low birth weight newborns (

RATIONALE Pentalogy of Cantrell (POC) is an extremely rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births. Its complete form includes a midline epigastric abdominal wall defect, defects affecting the lower sternum, anterior diaphragm, diaphragmatic pericardium, and various intracardiac defects. PATIENT CONCERNS We report a case of complete POC affecting only the first-born of a set of premature dizygotic twins. DIAGNOSIS A giant omphalocele with an eviscerated liver and bowel on prenatal, obstetric ultrasonography at 24 gestational weeks was observed. At birth, physical examination confirmed a massive (10 × 8 cm) epigastric omphalocele in which a significant part of the liver was seen. A postnatal echocardiogram revealed the presence of an ostium secundum atrial septal defect, perimembranous ventricular septal defect, and moderate pulmonary stenosis. X-ray showed an abnormal intrathoracic positioned stomach, which was confirmed with a plain x-ray of the upper intestinal tract with hydrosoluble contrast. Computed tomography (CT) scan revealed the sternum's absence and a close connection between the pericardial sac and the stomach wall. INTERVENTIONS The patient underwent surgical intervention at 18 days of age. OUTCOMES Despite adequate and appropriate postoperative treatment, the baby rapidly deteriorated and died 72 hours after surgery. LESSONS POC is a complex, high-mortality syndrome whose management requires a multidisciplinary approach and meticulous planning. Despite all efforts, POC carries a poor prognosis, particularly in patients affected by its complete form.

Introduction. Obstetric ultrasonography is routinely used to screen for fetal anomalies. Thanatophoric dysplasia (TD) is one of the common though rare lethal skeletal dysplasia, detected during routine ultrasound scan. TD is caused by a mutation in FGFR3 gene. Characteristic features include shortening of limbs, macrocephaly and platyspondyly. In our local setting, it is common to miss the diagnosis in the early scans due to lack of expertise of the sonographers. To the best of our knowledge, this is the first publication from Ghana. Case Presentation. We present the case of a 33-year-old woman who was referred to the facility on account of ultrasound scan report suggestive of thanatophoric dysplasia type 1 at 34 weeks of a female baby. The diagnosis was not made despite the mother being a regular antenatal attendant, until a fifth scan done at 34 weeks reported features suggestive of thanatophoric dysplasia. The ultrasound scan features included a biparietal diameter of 37weeks, femur length—24weeks, narrowed thoracic cage with hypoplastic lungs and short ribs. The liquor volume was increased with amniotic fluid index (AFI) of 38.4 cm. The femur, tibia, fibula, humerus, ulna, and radius were shortened (micromelia). The diagnosis of thanatophoric dysplasia type 1 was confirmed on autopsy. Conclusion. This report was aimed to highlight the potential contribution of ultrasound scan in the diagnosis of thanatophoric dysplasia in our setting.

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.

The widespread use of obstetric ultrasonography has increased the detection rate of antenatal hydronephrosis. Although most cases of antenatal hydronephrosis are transient, one third persists and becomes clinically important. Ultrasound has made differential diagnosis possible to some extent. Ureteropelvic junction type hydronephrosis (UPJHN) is one of the most common cause of persistent fetal hydronephrosis and occurs three times more in male fetuses. It is usually sporadic and unilateral. However, when bilateral kidneys are involved and presents with severe hydronephrosis, the prognosis may be poor. Typical ultrasound findings of UPJHN is hydronephrosis without hydroureter. The size and appearance of the fetal bladder is usually normal without thickening of the bladder wall. Several grading systems are developed and increasingly being used to define the severity of prenatal hydronephrosis and provides much more information about prediction of postnatal renal prognosis. If fetal urinary tract dilation is detected; laterality, severity of hydronephrosis, echogenicity of the kidneys, presence of ureter dilation should be assessed. Bladder volume and emptying, sex of the fetus, amniotic fluid volume, and presence of associated malformations should be evaluated. Particularly the ultrasonographic signs of renal dysplasia, such as increased renal parenchymal echogenicity, thinning of the renal cortex, the presence of cortical cysts, and co-existing oligohydramnios should be noticed. Unfortunately, there is no reliable predictor of renal function in UPJHN cases. Unilateral hydronephrosis cases suggesting UPJHN are mostly followed up conservatively. However, the cases with bilateral involvement are still difficult to manage. Timing of delivery is also controversial.

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. .

Central nervous system (CNS) malformations play a role in all fetal malformations. Ultrasonography (US) is the best screening method for identifying fetal CNS malformations. A good echographic study depends on several factors, such as positioning, fetal mobility and growth, the volume of amniotic fluid, the position of the placenta, the maternal wall, the quality of the apparatus, and the sonographer’s experience. Although US is the modality of choice for routine prenatal follow-up because of its low cost, wide availability, safety, good sensitivity, and real-time capability, magnetic resonance imaging (MRI) is promising for the morphological evaluation of fetuses that otherwise would not be appropriately evaluated using US. The aim of this article is to present correlations of fetal MRI findings with US findings for the major CNS malformations.

Objective: Studies associate factors to the presence of congenital malformations of the central nervous system (CNS). Thus, this study aimed to determine the associated factors with congenital malformations of the CNS in newborns. Patients and Methods: Case-control study including patients from Latin American Collaborative Study of Congenital Malformations (ECLAMC). Maternal, gestational, neonatal, environmental and ultrasonographic variables were analyzed. Association between the congenital anomalies and these factors was estimated by “Odds Ratio” (OR). Results: Regarding the variables age and education of parents, number of pregnancies, prenatal consultations and ultrasound, gestational age, immunizations, maternal diseases and lifestyle, exposure to teratogenic substances and environmental factors, use of folic acid, ferrous sulfate and vitamins, as well as weight and gender of the newborn, there was no significant difference in frequency between both groups. The factors significantly associated to the malformations were the family history of congenital malformation of CNS and the presence of absolute or relative oligohydramnios in obstetric ultrasonography (OR = 5.33, p = 0.03 and OR = 8.42, p = 0.05). Conclusion: Congenital familiar malformation of CNS (1st and 2nd degree) and log absolute or relative of oligohydramnios in obstetric ultrasonography were considered associated factors with congenital malformations of the CNS. The investigation of aspects related to the presence of these malformations allows establishment of associated groups, early diagnosis and to promote relevant health activities aimed at primary and secondary prevention, with important prognostic neonatal implications.

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.

Over the years, there have been several improvements in ultrasound technologies including high-resolution ultrasonography, linear transducer, radiant flow, three-/four-dimensional (3D/4D) ultrasound, speckle tracking of the fetal heart, and artificial intelligence. The aims of this review are to evaluate the use of these advanced technologies in obstetrics in the midst of new guidelines on and new techniques of obstetric ultrasonography. In particular, whether these technologies can improve the diagnostic capability, functional analysis, workflow, and ergonomics of obstetric ultrasound examinations will be discussed.

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.

In Fiji, a Pacific island nation, ultrasonography practice is still in its infancy. Ultrasounds are performed by radiographers who independently interpret the ultrasonographic images and write the diagnostic reports on behalf of the radiologists. This paper presents research on the practices and procedures that are used to perform the mid‐trimester obstetric ultrasonography examinations at an urban public hospital in Fiji. The participants comprised a cohort of “on‐the‐job” trained radiographers, radiologists and obstetricians involved in obstetric ultrasonography. In‐field observations, questionnaires and interviews yielded predominantly qualitative data. The radiographers' scanning criteria were evaluated against the stipulated ASUM mid‐trimester guidelines. This study revealed that even the most experienced radiographers barely met 50% of ASUM's mid‐trimester scanning requirements. They spent less than five minutes performing a scan and insufficient expertise, training and supervision, excessive workload and a lack of resources were major constraints affecting the standards of ultrasonography practice in Fiji. However, the absence of a standard protocol was also a major cause for disparate scanning patterns amongst the radiographers. This paper highlights the gaps and limitations associated with the obstetric ultrasonography practice in Fiji, and suggests the need for international assistance in ultrasonography education.

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.