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Supplemental Digital Content is available in the text., Background: Abdominal aortic aneurysm (AAA) can occur in patients who are ineligible for routine ultrasound screening. A simple AAA risk score was derived and compared with current guidelines used for ultrasound screening of AAA. Methods: United Kingdom Biobank participants without previous AAA were split into a derivation cohort (n=401 820, 54.6% women, mean age 56.4 years, 95.5% White race) and validation cohort (n=83 816). Incident AAA was defined as first hospital inpatient diagnosis of AAA, death from AAA, or an AAA-related surgical procedure. A multivariable Cox model was developed in the derivation cohort into an AAA risk score that did not require blood biomarkers. To illustrate the sensitivity and specificity of the risk score for AAA, a theoretical threshold to refer patients for ultrasound at 0.25% 10-year risk was modeled. Discrimination of the risk score was compared with a model of US Preventive Services Task Force (USPSTF) AAA screening guidelines. Results: In the derivation cohort, there were 1570 (0.40%) cases of AAA over a median 11.3 years of follow-up. Components of the AAA risk score were age (stratified by smoking status), weight (stratified by smoking status), antihypertensive and cholesterol-lowering medication use, height, diastolic blood pressure, baseline cardiovascular disease, and diabetes. In the validation cohort, over 10 years of follow-up, the C-index for the model of the USPSTF guidelines was 0.705 (95% CI, 0.678–0.733). The C-index of the risk score as a continuous variable was 0.856 (95% CI, 0.837–0.878). In the validation cohort, the USPSTF model yielded sensitivity 63.9% and specificity 71.3%. At the 0.25% 10-year risk threshold, the risk score yielded sensitivity 82.1% and specificity 70.7% while also improving the net reclassification index compared with the USPSTF model +0.176 (95% CI, 0.120–0.232). A combined model, whereby risk scoring was combined with the USPSTF model, also improved prediction compared with USPSTF alone (net reclassification index +0.101 [95% CI, 0.055–0.147]). Conclusions: In an asymptomatic general population, a risk score based on patient age, height, weight, and medical history may improve identification of asymptomatic patients at risk for clinical events from AAA. Further development and validation of risk scores to detect asymptomatic AAA are needed.

Since its initial description in 1996 by Yii and Niranjan, the internal pudendal perforator flap (also known as the Singapore flap, the gluteal fold flap, and the lotus petal flap) has become a workhorse in perineal soft tissue reconstruction. In 2001, Hashimoto described the presence of three to five perforators in the perineal anogenital triangle. The ischial tuberosity has thus become a useful anatomic landmark for the safe boundary of medial dissection during flap elevation, in order to avoid damaging the perforator vessels. The objective of the present study was to evaluate the perforators’ positions within the anogenital triangle by using color Doppler ultrasound. In a study of 15 subjects in the lithotomy position, we identified a total of 24 perforator vessels with a diameter greater than 5 mm. We noted the vessels’ positions using orthonormal measurements, according to the distance from the midline and the distance on a straight line between the two ischial tuberosities (i.e. consistent bony anatomic landmarks that are independent of the patient's height and body mass index). The mean distance between the ischial tuberosity and the internal pudendal perforator was 27.3 mm. Based on our present results, we consider that routine ultrasound identification and dissection of the perforators is not always required before pudendal flap harvesting. This decreases the operating time and simplifies the flap harvesting procedure.

Routine ultrasound examinations by specialists are an essential part of prenatal care and should be performed even in the extraordinary situation of the COVID-19 pandemic. The routine of obstetric and gynecological ultrasound services during COVID-19 pandemic period was changed to increase the protection of the patient, her fetus and her family, as well as of health professionals involved in care. The impossibility of maintaining the recommended distance during the ultrasound examination requires rigorous and systematic precautions, because patients and health professionals are exposed to COVID-19 infection. Given the risk of COVID-19 transmission, the performance of ultrasound examinations in gynecology and obstetrics must be based on a priority assessment and in accordance with Febrasgo protocols. COVID-19 infection within health services must be avoided at all costs. Part of this strategy involves the surveillance of employees in the sector and the systematic use of personal protective equipment (PPE).

Background: The primary aim was to assess the diagnostic accuracy of routine ultrasound assessment for gallbladder polyps. The secondary aim was to identify the characteristics that differentiate neoplastic polyps from nonneoplastic polyps. Methods: A total of 156 patients with histopathologically proven gallbladder polyps in 4 Dutch hospitals between 2003 and 2013 were included. Sensitivity and specificity of ultrasound for polyp size, number of polyps, and polyp type were assessed using histopathological findings as a reference standard. In addition, diagnostic accuracy of sonographic size ≥1 cm for neoplasia was assessed. Subgroup analysis for patients with polyps as primary indication for cholecystectomy was performed. The sonographic polyp characteristics on preoperative routine ultrasound were described. Results: Fifty-six percent of gallbladder polyps were preoperatively identified on ultrasound, of which 31% were neoplastic. Sensitivity and specificity of ultrasound to estimate polyp size were 93 and 43% (subgroup; 92 and 33%). Sensitivity and specificity of sonographic polyp size ≥1 cm for neoplasia were 86 and 32% (subgroup; 94 and 26%). No specific sonographic characteristics for neoplastic polyps could be established due to lack of reporting. Conclusion: Routine ultrasound assessment of polyps is associated with overestimation of polyp size and low specificity of sonographic size ≥1 cm for neoplasia, which contributes to surgical overtreatment of nonneoplastic polyps.

ObjectivesOver the past decade, clinical practice guidelines and educational campaigns have counselled against the use of routine ultrasound (US) in the diagnosis of undescended testes (UDT). We aimed to establish whether or not there has been change in the proportion of children with UDT undergoing pre-referral US prior to referral to our centre over this period. We also sought to determine whether type of referring specialist, UDT diagnosis, and patient distance from the hospital had impacted the rate of pre-referral US.MethodsA select sample of hospital charts of children undergoing orchidopexy at a single tertiary paediatric urological referral centre between 2010 and 2019 were reviewed. Data regarding age at surgery, cryptorchidism diagnosis, type of referring physician, patient distance from institution, and evidence of US as part of diagnostic work-up were extracted.ResultsFive hundred charts were examined. Referring provider specialty impacted the number of US ordered (P=0.01). On subset analysis, paediatricians ordered fewer US for children with palpable UDT in 2014 (P=0.03). In 2018, community urologists ordered no US (P=0.02). These findings had temporal relationships with guideline release. The proportion of children undergoing US each year remained consistently between 50% and 62%, except in 2014, when only 36% had US. Distance from hospital and UDT diagnosis were of no significance.ConclusionDespite clinical practice guidelines and Choosing Wisely campaign recommendations, significant numbers of children with UDT still undergo US. Transient changes in sub-specialty guideline adherence are observed. Strategies to improve sustained guideline awareness in referring clinicians need to be considered.

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis. Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination. Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty. Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.

This study aimed to examine the benefits of routine use of 2D-US in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR).Two-dimensional ultrasound (2D-US) reduces access-related vascular complications (VCs) and bleeding in patients undergoing percutaneous coronary intervention via transfemoral approach. Potential similar benefits in patients undergoing transfemoral TAVR have not been systemically investigated.Rates of access-related VCs or bleeding were compared using 5-year retrospective observational data from 2 neighboring high-volume UK TAVR centers systemically using 2 different techniques (center 1: fluoroscopy and contralateral angiography [FCA], center 2: 2D-US) for femoral puncture at the time of transfemoral TAVR.Overall, 1,171 patients were included in the study (FCA, n = 624; 2D-US, n = 529). Baseline clinical and procedural characteristics were similar between the 2 groups. There was no difference in the risk of VCs, bleeding, or their composite according to femoral puncture technique (FCA vs. 2D-US: 6.7% [95% confidence interval (CI): 4.9% to 8.9%] vs. 6.8% [95% CI: 4.8% to 9.3%]; p = 0.63; 6.1% [95% CI: 4.4% to 8.2%] vs. 6.4% [95% CI: 4.8% to 9.3%]; p = 0.70; and 9.8% [95% CI: 7.6% to 12.4%] vs. 9.8% [95% CI: 7.4% to 12.7%]; p = 0.76, respectively) and no difference when analysis was restricted to a composite of major VCs or major and life-threatening bleeding.Vascular and bleeding complications can be achieved using either FCA or 2D-US guidance. Further studies are required to identify and assess alternative strategies to reduce periprocedural VCs and bleeding in this patient population.

Background The use of ultrasonography in the intensive care unit (ICU) is steadily increasing but is usually restricted to examinations of single organs or organ systems. In this study, we combine the ultrasound approaches the most relevant to ICU to design a whole-body ultrasound (WBU) protocol. Recommendations and training schemes for WBU are sparse and lack conclusive evidence. Our aim was therefore to define the range and prevalence of abnormalities detectable by WBU to develop a simple and fast bedside examination protocol, and to evaluate the value of routine surveillance WBU in ICU patients. Methods A protocol for focused assessments of sonographic abnormalities of the ocular, vascular, pulmonary, cardiac and abdominal systems was developed to evaluate 99 predefined sonographic entities on the day of admission and on days 3, 6, 10 and 15 of the ICU admission. The study was a clinical prospective single-center trial in 111 consecutive patients admitted to the surgical ICUs of a tertiary university hospital. Results A total of 3003 abnormalities demonstrable by sonography were detected in 1275 individual scans of organ systems and 4395 individual single-organ examinations. The rate of previously undetected abnormalities ranged from 6.4 ± 4.2 on the day of admission to 2.9 ± 1.8 on day 15. Based on the sonographic findings, intensive care therapy was altered following 45.1% of examinations. Mean examination time was 18.7 ± 3.2 min, or 1.6 invested minutes per detected abnormality. Conclusions Performing the WBU protocol led to therapy changes in 45.1% of the time. Detected sonographic abnormalities showed a high rate of change in the course of the serial assessments, underlining the value of routine ultrasound examinations in the ICU. Trial registration The study was registered in the German Clinical Trials Register (DRKS, 7 April 2017; retrospectively registered) under the identifier DRKS00010428.

The rapid development achieved over the last decades in volume rendering of ultrasound data, known as three-dimensional (3D) ultrasound technique, leads to new opportunities for refining the diagnosis in many gynaecologic conditions. The aim of the present study was to evaluate the advantages of 3D ultrasound over two-dimensional (2D) ultrasound in uterine pathology and to establish the optimal time point during the menstrual cycle to perform 3D ultrasound examination in order to achieve the maximum of useful information. A cross-sectional study on 200 patients who underwent gynaecologic 2D and 3D ultrasound examinations was performed. The addition of 3D examination to 2D ultrasound in uterine pathology provided the most useful information concerning: Congenital uterine anomalies, intrauterine devices (IUDs), adenomyosis, and submucous myomas. The findings showed that the 3D ultrasound scan is a useful tool in gynaecology, especially in cases with congenital uterine anomalies, myoma, and IUD. Although initially it was used for research purposes only, recent findings suggest its usefulness in routine ultrasound scan and the possibility of witnessing its introduction as a recommended examination procedure in the foreseeable future. Further research should be conducted in order to establish the sensitivity of 3D ultrasound in the detection of minor endometrial conditions, by correlating the imaging findings with the hysteroscopic results.

La hiperreacción luteínica es una entidad poco frecuente del embarazo, que se caracteriza por aumento bilateral y funcional de los ovarios con presencia de quistes de paredes finas. Varias hipótesis sugieren que es causada por el aumento de las concentraciones o la sensibilidad ovárica a la gonadotropina coriónica. La mayoría no presenta síntomas o complicaciones del embarazo, y el diagnóstico se realiza en forma accidental por ecografía de rutina. Es una condición benigna rara, suele autolimitarse y se resuelve espontáneamente después del parto. Sin embargo, a veces no pueden ser diferenciados de los tumores malignos de ovario sin un examen histológico. La cirugía está indicada cuando existen complicaciones como torsión ovárica o peritonitis por hemorragia o rotura. Se presenta un caso de hiperreacción luteínica durante el tercer trimestre del embarazo.

Benign liver tumors are often detected during routine ultrasound examinations or as an incidental finding in radiological imaging. Only very few benign liver tumors are at risk of becoming malignant. In the majority of cases the differentiation from malignant tumors is currently carried out using imaging procedures. In a few cases of diagnostic uncertainty, a transcutaneous liver biopsy can lead to clarification. If the suspicion of malignancy is substantiated or this cannot be excluded with absolute certainty, the tumor should be removed by partial liver resection.

Cleft lip and cleft palate (orofacial cleft) are facial and oral malformations that occur very early in pregnancy. A cleft lip and cleft palate, known technically as an orofacial cleft, is actually a group of various conditions that involve a ‘cleft” on the patient’s face. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly. Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together. Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth. Cleft lip with or without cleft palate, can be diagnosed during pregnancy by a routine ultrasound. They can also be diagnosed after the baby is born, especially cleft palate. Treatment with orofacial clefts can vary depending on the severity of the cleft; the child’s age and needs; and the presence of associated syndromes or other birth defects, or both.

Objective To investigate the clinical value of ultrasound plus magnetic resonance imaging (MRI) for the diagnosis of breast masses and fibroids. Methods Clinical data for 357 patients with breast masses diagnosed at our hospital were analyzed retrospectively. The diagnostic performances were compared between 243 patients who underwent routine ultrasound examinations (control group) and 114 patients who underwent routine ultrasound plus MRI (test group). Results The overall accordance rates of routine ultrasound and routine ultrasound plus MRI for the diagnosis of breast masses, based on postoperative pathological diagnoses, were 70.78% (172/243) and 90.35% (103/114). The addition of MRI significantly improved the overall diagnostic performance of routine ultrasound for breast masses. The diagnostic accordance rate of routine ultrasound for the diagnosis of breast fibroids (fibroadenomas) was 74.12% (63/85 cases) compared with 93.94% (31/33 cases) for routine ultrasound plus MRI. The diagnostic performance of routine ultrasound plus MRI was therefore also significantly higher than routine ultrasound alone for diagnosing breast fibroids. Conclusions Routine ultrasound plus MRI can greatly improve the diagnostic accordance rates for breast masses and fibroadenomas.

PubMedID: 30836012 Background: Antenatal care is necessary for mother and infant by reducing or eliminating the risks which may occur in the antenatal and postnatal period. Ultrasound is one of the most commonly used examination methods in antenatal monitoring. Evaluating the expectations, experiences and reactions of both parents during routine ultrasound examinations is essential to provide the best antenatal care. Objective: This study aims to test the validity and reliability of the PEER-U scale developed for Sweden by Ekelin et al. Method: The PEER-U scale consists of before and after ultrasound scales. Four hundred and thirty-six parents participated in the study. Interviews were conducted with all participating parents in a private room 15 minutes before and five minutes after the ultrasound. Researchers analysed the PEER-U scale for language, content, construct, criterion-referenced validity and internal consistency reliability. Results: The Turkish version of PEER-U has 21 items in the before ultrasound scale and 21 items in the after ultrasound scale. Cronbach's alpha was 0.65 for the before ultrasound scale and 0.89 for the after ultrasound scale. Conclusion: The study determined that the Turkish version of the PEER-U scale is a valid and reliable scale for Turkish society. © 2019, © 2019 Society for Reproductive and Infant Psychology.

Very preterm infants are at risk for cerebellar injury and impaired cerebellar growth with adverse neurodevelopmental outcome. Ultrasound through the mastoid fontanel (MF) with a curved-array or sector probe is the most established method for the sonographic examination of the cerebellum. The goal of our study was to examine the validity of transnuchal ultrasound through the foramen occipitale magnum (FOM) with a linear probe for monitoring postnatal cerebellar growth. Retrospective analysis of routine ultrasound scans through FOM and MF in 105 preterm infants born between 23 and 36 weeks of gestation with a birthweight of less than 1500 g. Diameters of the cerebellar hemispheres obtained through the two acoustic windows mastoid fontanel and foramen occipitale magnum showed high correlations (r's = 0.981 and 0.983, p's 0.001). Corrected gestational age was significantly associated with transverse cerebellar diameter (TCD) on the first scan (r = 0.908, p 0.001) as well as postnatal cerebellar growth (r = 0.920, p 0.001). Postnatal growth was slightly decreased resulting in cerebellar growth restriction on serial scans. Both associations exceeded the calculated ratio of TCD to head circumference (r = 0.657, p 0.001) and TCD to biparietal diameter with gestational age (r = 0.705, p 0.001). Transnuchal ultrasound is feasible for examination of the preterm cerebellum and improves image quality compared to scans through the MF with higher resolution at a very short distance. Monitoring cerebellar growth during early postnatal life via transnuchal ultrasound can help to identify children at high risk for neurodevelopmental impairment.ZIEL: Bei extrem Frühgeborenen besteht das Risiko für Kleinhirnschädigungen und für eine Beeinträchtigung des Kleinhirnwachstums mit nachteiligen Auswirkungen auf die neurologische Entwicklung. Ultraschall durch die Mastoid-Fontanelle (MF) mit einer gekrümmten Array- oder Sektorsonde ist die etablierteste Methode zur sonografischen Untersuchung des Kleinhirns. Ziel unserer Studie war es, die Validität von transnuchalem Ultraschall durch das Foramen occipitale magnum (FOM) mittels Linear-Schallkopf zur Überwachung des postnatalen Kleinhirnwachstums zu untersuchen. Retrospektive Analyse von Routine-Ultraschalluntersuchungen durch FOM und MF bei 105 Frühgeborenen zwischen 23 und 36 Schwangerschaftswochen mit einem Geburtsgewicht von weniger als 1500 g. Die Durchmesser der Kleinhirnhemisphären, die durch die beiden akustischen Fenster von MF und FOM gemessen wurden, zeigten hohe Korrelationen (r’s = 0,981 und 0,983; p 0,001). Das korrigierte Gestationsalter war signifikant mit dem transversalen Kleinhirndurchmesser (TCD) beim ersten Scan (r = 0,908; p 0,001) sowie dem postnatalen Kleinhirnwachstum (r = 0,920; p 0,001) assoziiert. Das postnatale Wachstum war leicht vermindert, was zu einer Einschränkung des Kleinhirnwachstums bei seriellen Scans führte. Beide Assoziationen übertrafen die berechnete Ratio von TCD zum Kopfumfang (r = 0,657; p 0,001) und von TCD zum biparietalen Durchmesser (r = 0,705; p 0,001) gegenüber dem Gestationsalter. Transnuchaler Ultraschall kann für die Untersuchung des Zerebellums des Frühgeborenen eingesetzt werden und verbessert, im Vergleich zu Aufnahmen durch die MF, die Bildqualität bei höherer Auflösung in sehr kurzer Distanz. Die Überwachung des Kleinhirnwachstums mittels transnuchalem Ultraschall in der frühpostnatalen Phase kann helfen, Kinder mit hohem Risiko für neurologische Entwicklungsstörungen zu identifizieren.

Objective Most genetic disorders, especially rare and manifested with an unspecific constellation of developmental anomalies, are challenging to diagnose before birth. The paper aims to present a rare case of terminal 21q22 deletion to extend the knowledge on this rare genetic disease, mostly to facilitate prenatal guidance by pointing the diagnostic features. Case report The fetus was diagnosed prenatally, at 21 weeks of gestation, due to ultrasound markers detected in a routine ultrasound scan. Post-mortem dysmorphological assessment has verified the diagnosis. To the best of our knowledge, this is the second report of prenatal presentation of partial monosomy 21q. Conclusion By giving the detailed phenotype description and presenting a comprehensive literature review on the subject, we delineate its phenotype, which was different from what has been shown in the literature. Specifically, the clinical presentation of aberration within regions 2 and 3 (referring to the term proposed by Lyle et al., in 2009) of 21q22 bands is not characterised by multiple or severe malformations, which matters for prenatal counselling and diagnostics.

Background Schwannomas are rare benign tumors that arise from the Schwann cells of the nerve sheath. Schwannomas are characteristically indolent, growing approximately 1–3 mm a year. We report a case of cervical sympathetic chain schwannoma (CSCS) with a rapid rate of growth while being regularly imaged for another disease process. Methods A 57-year-old female with a history of papillary thyroid cancer (PTC) presented with a left level IV neck mass discovered on a routine ultrasound. The mass was not visualized on her most recent ultrasound 11 months prior. Results The patient underwent extracapsular enucleation of the schwannoma, which arose from the cervical sympathetic chain. Final pathology confirmed the diagnosis of a benign schwannoma. Conclusions This case serves as a reminder that not all benign CSCSs are indolent and also highlights the fact that the rapid rate of growth of these lesions is not necessarily indicative of a malignant transformation.

In the last decades, the incidence of thyroid cancer (TC) has more than doubled, but the disease-specific mortality rate was stable. To date, 30–40% of all TC is represented by papillary microcarcinomas (mPTC), an indolent tumor, that probably remained undiagnosed before routine ultrasound use. In 1993, Miyauchi was the first who hypothesized a conservative approach for low-risk mPTC and introduced the concept of active surveillance (AS) in its clinical management. The progression rate of mPTC during AS was low and delaying surgery did not impact the efficacy of treatment or outcome. Since then, several authors from all over the world have reported their experience of AS in mPTCs. As suggested by current guidelines, AS can be considered as an alternative to immediate surgery to avoid overtreatment in low-risk mPTC and may be the strategy to avoid complications from unnecessary surgery. In the last years, AS inclusion criteria have been extended to both bigger tumors and to younger/healthier patients. The adoption of AS should take into consideration not only tumor characteristics but also patient psychological profiles and medical team expertise. Its safety and efficacy have been demonstrated in long-term outcome studies and in other types of tumors; however, skepticism in patients, families and physicians should be overcome by strong recommendations coming from scientific guidelines. This review analyses the several and different experiences of AS and the potential obstacles in implementing it as a routine approach in mPTC patients.

Background The Western Australian Preterm Birth Prevention Initiative was officially launched in November 2014. It demonstrated an initial decrease in the preterm birth rate in Western Australia. One of the key points of this initiative is the routine ultrasound measurement of the cervical length in mid-pregnancy. Aim The aim of this study was to evaluate the perceptions and attitudes of Western Australian women regarding transvaginal cervical length (TVCL) screening for preterm birth prevention. Materials and methods Self-administered questionnaires were completed by pregnant women before and after their mid-trimester obstetric ultrasound. Maternal demographical and medical data were collected in addition to opinions of TVCL screening. Results A total of 598 women participated with the maternal age range representative of the Western Australian obstetric population. There was a high rate of acceptance of TVCL imaging, with 2% of the 149 women declining a transvaginal ultrasound (TVU) offered in this study, 1.5% refusing a TVU in the past and 5.7% reporting that they would have a concern in having a TVU in the future. Women stated that they either had declined TVCL in the past (11%) or would decline in the future (30.7%) as they wanted to discuss the procedure with their clinician first, had been advised not to have a TVU by their clinician (11% in the past and 47.7% in the future) or felt uncomfortable with the operator (22% at a previous TVU and 34.4% in the future). Conclusion Pregnant women participating in this study had a high acceptance of TVCL screening for preterm birth prevention.

Background: Intrauterine growth restriction (IUGR) and its early detection were correlated with a high risk of perinatal mortality and morbidity and management are helpful in decreasing the neonatal risks. Transcerebellar diameter to abdominal circumference ratio becomes a gestational age independent parameter, which may be helpful for early detection of IUGR. Objectives: Study the accuracy of transcerebellar diameter/abdominal circumference ratio (TCD/AC ratio) for the evaluation of normal fetal development. Patients and methods: Our Prospective observatory research included 500 women with uncomplicated pregnancy attending the outpatient clinic of Al Azhar university hospitals for routine antenatal care. Routine ultrasound parameters were measured as well as transcerebellar diameter. In all patients, the TCD/AC ratio was also determined. Results: Our study concluded that difference in TCD/AC ratio between patients with IUGR vs. patients with no IUGR is statistically significant with p value 13 this cutoff value with 99.03 % sensitivity and 83.45 % specificity, 58.0 with a positive predictive value and 99.7 with a negative predictive value. Conclusions: TCD/AC ratio seems to become an age-independent constant parameter and a comparatively good IUGR indicator in gestational age groups of 18-34 weeks which may be helpful for early identification of fetal intrauterine growth retardation (IUGR).

To date, a large number of research studies show that during pregnancy, in addition to the individual transformations of mothers and fathers, there is the birth of the emerging coparenting relationship. Direct observation is crucial to assessing the coparenting subsystem, and the advent of the prenatal version of the Lausanne Trilogue Play (Fivaz-Depeursinge and Corboz-Warnery1999) was a milestone for studies on prenatal coparenting. Even more complex than prenatal observations of coparenting is the collection and analysis of coparenting representations during pregnancy. This chapter aims to present some preliminary findings concerning prenatal coparenting interactions and representations. Twenty primiparous couples were observed during an adapted version of the Prenatal Lausanne Trilogue Play, (PLTP; Carneiro et al., 2006), which replaced the doll in the PLTP with a short video of the couples’ fetus recorded during their last 4D routine ultrasound. We found that the fetal image in the 4D ultrasound video triggered some coparenting and intuitive parenting behaviors such as smiles and baby talk toward the fetus. At a representational level, extracts from our conjoint semi-structured interview with pregnant couples showed different ways in which couples prepare for their transition to becoming a family.

Background Ultrasound is a routine procedure performed during pregnancy to monitor the status of the human fetus, including the development of the digestive tract. The aim of this publication was to determine the shape of the fetal sigmoid colon mesentery during the first and second trimester of pregnancy by means of ultrasound. Methods The study was performed in 45 pregnant women (age: 36.4 years on average, range 25–45) during a routine ultrasound examination. The fetuses were between 12 and 22 weeks of pregnancy. The shape of the fetal sigmoid colon mesentery was analyzed. Results We visualized the triangular shape of the mesentery in all 45 cases. A prevalence of scalene or isosceles acute triangles was found in both trimesters. At the 12−13 weeks we observed 5 different forms of mesenteric triangles – the scalene or isosceles acute triangles appeared at 33.3% and 28.6%, respectively. The obtuse scalene was present in 23.8 %. In the 2nd trimester (20−22 weeks) 4 types were found, among them 37.5 % acute scalene and 33.3 % acute isosceles. Conclusions The fetal sigmoid colon mesentery can be visualized from the 12th week of pregnancy. The triangular shape of the sigmoid colon mesentery is easy to follow during routine ultrasound examinations.

Introduction: The prenatal diagnosis of conotruncal defects (CTDs) has improved over the past decade, particularly with inclusion of outflow tract imaging at routine ultrasound. Appropriate prenatal counseling for CTDs demands an accurate diagnosis, as even more subtle cardiac pathology could complicate clinical outcomes. We sought to determine the anatomical accuracy of fetal echocardiography in evaluating common CTDs and factors that contribute to accuracy. Methods: All cases of tetralogy of Fallot(TOF), double outlet right ventricle(DORV) and truncus arteriosus(TA) encountered in our institution from 2007-2018 were reviewed. Discrepancies in anatomical findings between prenatal (most accurate exam) and postnatal (echo/surgery) or autopsy exams were categorized as: C1) no difference C2) minor difference with no impact on outcome (e.g.aberrant right subclavian artery), C3) minor difference that could make a minor difference to the delivery plan or surgery (e.g.branch pulmonary artery stenosis), C4) major difference that changes the course of the pregnancy, delivery or surgical planning (e.g.ductal dependency). Results: Of the 255 CTD cases, 162 had prenatal and postnatal and/or autopsy data available. Of the 162, 107(65.6%) fit C1, 35(21.5%) C2, 12(7.4%) C3, and 8(5.5%) C4. The greatest accuracy was observed in TOF, with 69/71(97.2%) in C1 and C2 versus 56/69(81.2%) in DORV and 16/22(72.7%) in TA(p=0.003). Excluding 5 cases at 10-16weeks, there was a tendency towards a greater proportion in C1 and C2 when examined at 17-23 weeks (60/64, 93.4%) versus 24-32 weeks (50/57, 87.7%) and >32 weeks (28/36, 77.8%) (p=0.06). Era of assessment also revealed a difference with 43/55(78.2%) of studies performed from 2007-2011 in C1 and C2 versus 99/107(92.5%) from 2012-2018 (p=0.01).When we compared pregnancies with one versus serial exams, we observed a lower proportion of C4 cases from 9.6% to 2.7%, respectively. In those with serial exams, 20% had achieved C1 or C2 only at serial exam. Conclusions: The diagnostic accuracy of fetal echocardiography in CTDs is generally high, especially for TOF and when performed at 17-24weeks. There has been significant improvement in accuracy since 2011. Serial exams potentially improve diagnostic accuracy.

Objectives To evaluate cranial ultrasound markers during a first-trimester routine ultrasound examination for screening for open spina bifida (OSB). Methods Midsagittal and axial images of the fetal head obtained from fetuses with spina bifida and unaffected control fetuses at 11 weeks to 13 weeks 6 days were analyzed retrospectively. The observed markers of the posterior brain included the 4- versus 3-line view, the brain stem (BS)-to-brain stem-occipital bone (BSOB) distance ratio (BS/BSOB), the position relationship between the maxillo-occipital (MO) line and the midbrain-BS junction, and the crash sign status. Results This study included 9 OSB cases, 2 closed spina bifida (CSB) cases, and 200 unaffected controls. Eight of 9 OSB cases had informative midsagittal views of the head. The 3-line view (abnormal) and BS/BSOB greater than 1 (abnormal) were observed in 87.5% (7 of 8) and 100% (8 of 8), respectively. The midbrain-BS junction was below or nearly on the MO line (abnormal) in 100% (8 of 8). Seven of the cases had informative axial views of the head. The crash sign (abnormal) was observed in 85.7% (6 of 7). A 3-line view was seen in all of the cases that had a positive crash sign. Neither of the 2 cases of CSB and none of the controls had any of the 4 first-trimester intracranial ultrasound markers of OSB. Conclusions The 4 first-trimester intracranial ultrasound markers investigated in this study appear to be very good markers of OSB, especially a BS/BSOB greater than 1 and an abnormal MO line. The crash sign and 3-line view were observed in the same fetus. In our study, these ultrasound findings were not helpful in CSB.

Objective: The aim of the study was to gain updated data on SHS exposure among pregnant women in Chongqing city, one of the four municipalities of China. Study Design and Setting: Pregnant women attending routine ultrasound checks at an obstetrics and gynecology center voluntarily participated in the survey of SHS exposure. Some participants were also invited to have saliva cotinine tests using a NicAlert kit. The pulsatility index (PI) of the umbilical artery was compared between the SHS and non-SHS groups. Results: A total of 548 pregnant women (74.82 and 25.18% at 12 and 24 weeks' gestation, respectively) participated in the survey from July to November 2019. SHS exposure was reported by 29.44% of participants. “Workplace” was listed as the top location for SHS exposure. Twenty-three of the 31 participants who tested cotinine-negative in their saliva samples self-reported SHS exposure in the survey questionnaire. However, two of the eight participants who tested cotinine-positive in their saliva samples self-reported SHS-exposure negative. The mean PI in the SHS group is higher than that in the non-SHS group (1.10 vs. 1.02) in fetuses at 24 weeks' gestation. However, the PI may not be suitable as an index for SHS exposure at 12 weeks' gestation due to frequent absent or reversed diastolic flow. Conclusion: The first survey on SHS exposure in pregnant women that combines a questionnaire, saliva cotinine tests, and ultrasound flow index analysis has been performed in China and provided valuable data for ensuing studies.

There is significant variation in practices concerning Roux-en-Y gastric bypass (RYGB) among bariatric surgeons, but there is currently a lack of robust data on the nature and extent of these variations. The purpose of this study was to understand global variations in practices concerning RYGB. A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms. The link was also distributed through a personnel email network of authors. A total of 657 surgeons from 65 countries completed the survey. Crohn’s disease and liver cirrhosis were considered absolute contraindications for RYGB by 427 surgeons (64.98%) and 347 surgeons (53.30%), respectively. More than 68.5% of surgeons performed routine upper GI endoscopy while 64.17% performed routine ultrasound of abdomen preoperatively. The majority of surgeons (77.70%) used the perigastric technique for Gastric pouch creation. Approximately, 79.5% used orogastric bougie. More than 70% of the respondents did not use any staple line reinforcement routinely. Only 17.67% of surgeons measured the whole small bowel length, and the majority of surgeons (86.5%) used constant length of BP limb. Approximately, 89% used constant length of alimentary limb. Approximately, 95% of surgeons preferred antecolic bypass, and more than 86% routinely closed the Petersen defect. Marginal ulcer prophylaxis was used by the majority (91.17%). Almost 95% of surgeons recommended lifelong vitamin and mineral supplements. This survey identifies global variations in practices concerning RYGB. It identifies several areas for future research and consensus building.

Introduction Evidence-based information regarding the use of medication during pregnancy is lacking, even though the use of medication during pregnancy is considered common and often neccesary. The aim of this study was to obtain reliable information on the use of medications during the first 20 weeks of pregnancy and the use of vitamins, minerals, fatty acids, herbs and other natural products. Women´s attitude and beliefs towards the use of medications was also examined. Material and methods The study was conducted at the Prenatal Diagnosis Unit at Landspitali from January to April 2017. Women who attended routine ultrasound examination at 20 weeks were offered to participate. A questionnaire was submitted to partici-pants in an interview with the researcher following the doctor's appointment. Results Of the 213 participants, 90% used medication at least once during the first 20 weeks of pregnancy. Approximately 80% of these medications belong to FASS safety classes A and B and are considered safe during pregnancy. The proportion of women who did not use folic acid was 14% which was associated with residence in rural areas (p=0.03) and younger age (p=0.019). Natural products were used by 14% but information about their safety is lacking. The majority (81%) was satisfied with the information they received when a drug was prescribed and 94% said they had sufficient access to information about medication use during pregnancy. The most commonly used sources of information were the internet (51%) and the local midwive (44%). Conclusion The use of medications and supplements during pregnancy is common. Most medications being used are considered safe during pregnancy. The majority of pregnant women take folic acid. Pregnant women have a logical and generally a positive attitude towards medication use during pregnancy.

Congenital heart disease (CHD) is one of the most common congenital anomalies reported. Incidence of CHD is 8–9 per 1000 live births in data published from the west. There is very little published data on the incidence of foetal cardiac anomalies in India. We tried to find out incidence and spectrum of foetal cardiac anomalies in second and third trimester during routine ultrasound examination in a primary referral centre. Of 11,760 fetuses in the 2nd and 3rd trimester, 104 were found to have cardiac anomalies with incidence of 8.8 per 1000. Ventricular septal defect was the most common lesion, followed by chamber asymmetries and outlet abnormalities.

Background. Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer’s syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer’s syndrome. Case Presentation. We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer’s syndrome. Conclusion. Prolonged pyrexia with loss of weight and Stauffer’s syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.

Clinical/methodical issue Focal liver lesions are commonly seen during routine ultrasound examinations. Standard radiological methods With native ultrasound there are lesions that cannot be sufficiently characterized. In these cases additional imaging might be necessary. Methodical innovations With contrast-enhanced ultrasound (CEUS), focal liver lesions can be characterized with high diagnostic accuracy. After the ultrasound contrast agent has been injected into a peripheral vein, the examiner saves video loops of the arterial, portal venous and late contrast phases. Combing the findings of native and contrast-enhanced ultrasound allows not only assessment of the etiology as benign or malignant but also detailed characterization of the focal liver lesion in most cases. Performance Using CEUS, focal liver lesions can be characterized with a sensitivity of over 95% and a specificity of about 83%. Achievements The advantages of CEUS include that there is no radiation exposure and that the ultrasound contrast agent has no effects on the function of the liver, kidneys or the thyroid gland. The main limiting factors for CEUS are bowel gas and obesity of the patient. Practical recommendations CEUS can visualize micro- and macrovascularization of benign focal liver lesions in real time. It is a useful imaging modality in unclear cases.

Diagnosis of large, heterogenous lesions of the pancreas with solid and cystic components is often challenging. The spectrum of differential diagnoses is broad, and clinical as well as radiological findings may be similar. Detailed analysis of a clinical case and review of literature We present the case of a 28-year-old woman with a large, heterogenous tumour of the pancreatic head that was incidentally found in routine ultrasound during pregnancy. The presence of a solid pseudopapillary neoplasm (SPN) was suspected because of typical clinical and radiological characteristics. The patient underwent partial pancreatoduodenectomy and surprisingly, histological work-up confirmed a pancreatic extra-gastrointestinal stromal tumour (EGIST). As clinical and radiological findings may be misleading in a large, heterogenous tumour of the pancreas, a biopsy with histological proof of diagnosis is recommended, especially in situations where a neoadjuvant treatment may be considered.

Pregnancy in rudimentary horn is extremely rare and usually terminates in rupture during first and second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture is difficult and can be missed in routine ultrasound scan; and in majority of cases, it is detected after rupture. It requires high index of suspicion. We present a case report of a woman who was misdiagnosed as having missed miscarriage; and termination was attempted, which ended up in failure and rupture of rudimentary horn was the consequence followed by laparotomy. With advances in prenatal ultrasound in recent decades, it is prudent to detect such a life-threatening condition earlier resulting in a lower incidence of maternal morbidity and mortality.

Ultrasound is an extremely useful tool of thyroid investigation showing different aspects from previously unknown nodules to high-risk lesions requiring immediate surgery. We aim to introduce a pictorial assay of a series cases from two tertiary Romanian centres of endocrinology underling different scenarios from detection to management. All female patients associated normal thyroid function and lack thyroid antibodies while thyroid ultrasound proved essential in detection and follow-up the thyroid condition. Case 1 is a 49-year old subject admitted after an episode of palpitations and detected with a left thyroid nodule of 4.9 by 2.7 by 4.9 cm with inhomogeneous pattern and relatively regular shape requiring surgery. Case 2 is a 63-year old patient accusing dizziness and requiring Doppler ultrasound for carotid arteries that incidentally pointed a thyroid nodule. Ultrasound confirmed a right lobe nodule of 1.1 by 0.6 by 1 cm in association with another small thyroid nodule of 0.8 by 0.6 by 0.6 cm having egg shell peripheral calcifications. Fine needle aspiration was indicated and follicular aspects were identified. Case 3 is a 56-year old female admitted for menopausal osteopenia and routine ultrasound found a hypo-echoic nodule of 2.5 cm at right lobe. Case 4 is a 67-year female who was actually post-operatory confirmed with pT3aN1M0 papillary cancer starting from a first ultrasound evaluation of the thyroid. Case 5 is a 23-year old patient with a nodule detected by ultrasound three years ago and currently appreciated with a considerable increase even BETHESDA 2 was found initially through fine needle aspiration. Conclusion. As pointed by present series of cases, thyroid ultrasound represents an essential method in the hands of endocrinologists.

During routine ultrasound assessment of the fetal brain for biometry estimation and detection of fetal abnormalities, accurate imaging planes must be found by sonologists following a well-defined imaging protocol or clinical standard, which can be difficult for non-experts to do well. This assessment helps provide accurate biometry estimation and the detection of possible brain abnormalities. We describe a machine-learning method to assess automatically that transventricular ultrasound images of the fetal brain have been correctly acquired and meet the required clinical standard. We propose a deep learning solution, which breaks the problem down into three stages: (i) accurate localization of the fetal brain, (ii) detection of regions that contain structures of interest and (iii) learning the acoustic patterns in the regions that enable plane verification. We evaluate the developed methodology on a large real-world clinical data set of 2-D mid-gestation fetal images. We show that the automatic verification method approaches human expert assessment.

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

Background The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. Methods A longitudinal survey in early and late pregnancy among 2393 women in Sweden. Results Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. Conclusions Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.

Since 2009, the Society for Vascular Surgery has advocated annual surveillance imaging with ultrasound (US) after the first postoperative year for uncomplicated endovascular aneurysm repairs (EVARs). We sought to describe diffusion of US into long-term routine surveillance and to estimate potential cost savings among Medicare beneficiaries after EVAR.Using Medicare claims data, we identified patients receiving EVAR from 2002 to 2010 and included only those who did not subsequently have reinterventions, late aneurysm-related complications, or death. We collected all relevant postoperative imaging (computed tomography [CT] and US) through 2011. Patients with follow-up less than 1 year were excluded. We estimated cost savings with increased use of US after the first postoperative year.The cohort comprised 24,615 patients with a mean follow-up of 3.9 ± 2.3 years. Mean number of images decreased from 2.23 in the first postoperative year to 0.31 in the 10th year. Utilization of US at the first postoperative year remained low but increased from 15.2% in 2003 to 28.8% in 2011 (P 0.001). By the 10th postoperative year, the proportion of patients receiving US increased from 8.2% to 37.8%, while use of CT only remained high but decreased from 60.8% to 42.1%. Mean cost of surveillance imaging was $2,132/CT and $234/US. Performing US in 50-75% of patients beginning 1 year after EVAR would decrease costs by 14-48%/year. This translates to a mean cost savings of $338-$1135 per imaged patient per year, with an estimated savings to Medicare of $155 million to $305 million over 10 years.CT remains the primary modality of surveillance for up to 10 years after EVAR for patients without reinterventions or aneurysm-related complications. Increasing the use of US and decreasing the use of CT would save cost without compromising outcomes.

This study aimed to evaluate the advantages of routine ultrasound (US), contrast-enhanced US (CEUS), and the combination of these 2 methods in diagnosing papillary thyroid carcinoma (PTC). We subjected 89 patients with calcified thyroid nodules to conventional US and CEUS and then retrospectively analyzed the US and CEUS features of 89 patients with single, solid PTC. On this basis, we then evaluated the ability of US, CEUS, and their combination to diagnose PTC. In the 89 patients with thyroid nodules, US findings differed significantly from CEUS findings (P < 0.05). In the US group, the diagnostic sensitivity, specificity, and accuracy were 87.5%, 78.8%, and 88.0%, respectively; in the CEUS group, these values were 92.9% (P < 0.05), 87.9% (P < 0.05), and 92.9% (P < 0.05), respectively; and when the methods were combined, the diagnostic sensitivity, specificity, and accuracy were 96.7%, 92.7%, and 94.9%, respectively. A typical PTC nodule can be definitively diagnosed using US and CEUS; more specifically, the features of slow progression, late enhancement, and low enhancement were highly associated with a diagnosis of PTC. When these features were combined, they exhibited higher diagnostic performance than any individual method.

The article presents 3 clinical cases of asymptomatic placental abruption, diagnosed occasionally during routine ultrasound. There were analyzed risk factors of placental abruption: thrombophlia, diabetes, perinatal losses. All cases demonstrated complete coincidence of ultrasonic and morphological data in placental abruption. The patients had been delivered successfully due to correct diagnostics and severe maternal and fetal complications were not realized.

El síndrome congénito por el virus zika comprende una serie de malformaciones fetales, principalmente del sistema nervioso central, que comparten un patrón de atrofia cerebral y trastornos en la migración neuronal, y que tienen en la microcefalia su expresión más llamativa y más grave. La ultrasonografía cumple el papel más importante en el despistaje de lesiones cerebrales en los fetos de mujeres embarazadas expuestas a la infección por el virus zika, por lo que resulta evidente la trascendencia de establecer una evaluación sistemática en los controles ecográficos de rutina de las gestantes en las áreas de transmisión de la enfermedad. Asimismo, es importante destacar que la neurosonografía fetal es el estándar de referencia en la evaluación de la anatomía cerebral fetal y debería formar parte del algoritmo diagnóstico en todos los casos sospechosos. Congenital Zika virus syndrome comprises a series of fetal malformations, mainly of the central nervous system, that share a pattern of brain atrophy and disorders in neuronal migration, and that have in microcephaly their most striking and severe expression. Ultrasonography plays the most important role in the screening of brain lesions in the fetuses of pregnant women exposed to Zika virus, so the importance of establishing a systematic evaluation in the routine ultrasound controls of pregnant women in areas of transmission of the disease becomes apparent. It is also important to note that fetal neurosonography is the reference standard in the evaluation of fetal brain anatomy and should be part of the diagnostic algorithm in all suspected cases.