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Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the concordance between two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS) and magnetic resonance imaging (MRI) in the assessment of lung volume in fetuses with urinary tract malformations (UTM). Methods. This was a cross-sectional study involving 12 pregnancies between 19 and 34 weeks, with various fetal UTM. Pulmonary volume was obtained by 2DUS using the following equation: total lung volume = [right lung antero-posterior diameter ( X) × transverse diameter ( Y) × cranial-caudal diameter × 0.152 + left lung ( X1) × ( Y1) × ( Z1) × 0.167]. Pulmonary volume by 3DUS was obtained using the virtual organ computer-aided analysis (VOCAL) method with a 30° (VOL30), 18° (VOL18) and 12° (VOL12) rotation. A fast sequence of transverse lung section was also obtained by MRI. The intraclass correlation coefficient was used to evaluate the correlation between the three methods. The paired student t-test was used to compare the means. Results. There was a strong correlation between the three methods, and the highest correlations were between MRI and VOL18 for the right (ICC = 0.913) and left (ICC = 0.947) lungs. A strong correlation was also found between the lung volumes obtained through MRI and VOL12 as well as VOL18 ( p = 0.544 and 0.286, respectively). However, for the left lung there was only a correlation between MRI and VOL12 ( p = 0.49). Conclusions. There is a good concordance between 3DUS (VOL12) and MRI in the evaluation of lung volume in fetuses with UTM. [ABSTRACT FROM AUTHOR]

Beckwith-Wiedemann syndrome is a genetic syndrome characterized by macroglossia, omphalocele, fetal gigantism and neonatal hypoglycemia. The authors report a case of Beckwith-Wiedemann syndrome diagnosed in a 32-year-old primigravida in whom two-dimensional ultrasonography revealed the presence of abdominal wall cyst, macroglossia and polycystic kidneys. Three-dimensional ultrasonography in rendering mode was of great importance to confirm the previous two-dimensional ultrasonography findings. [ABSTRACT FROM AUTHOR]

Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Diagnosis of maternal primary CMV infection and fetal compromise can be difficult, as well as the fact that most infected child are asymptomatic at birth, which makes binomial CMV and pregnancy challenging. The treatment of pregnant women with CMV hyperimmunoglobulin (CMV-HIG) has shown promising results. However, as far as we know, no randomized trials of immunoglobulin therapy of CMV-infected fetuses are ongoing. We describe CMV-HIG administration for twin pregnancy as maternal and fetal infection early in gestation. The epidemiology, clinical manifestations, prevention strategies and treatment of CMV infections are reviewed. [ABSTRACT FROM AUTHOR]

Objective: To assess the fetal lumbosacral spine by three-dimensional (3D) ultrasonography using volume contrast imaging (VCI) omni view method and compare reproducibility and agreement between three different measurement techniques: standard mouse, high definition mouse and pen-tablet., Methods: A comparative and prospective study with 40 pregnant women between 20 and 34 + 6 weeks was realized. 3D volume datasets of the fetal spine were acquired using a convex transabdominal transducer. Starting scan plane was the coronal section of fetal lumbosacral spine by VCI-C function. Omni view manual trace was selected and a parallel plane of fetal spine was drawn including interest region. Intraclass correlation coefficient (ICC) was used for reproducibility analysis. The relative difference between three used techniques was compared by chi-square test and Fischer test., Results: Pen-tablet showed better reliability (ICC=0.987). In the relative proportion of differences, this was significantly higher for the pen-tablet (82.14%; p<0.01). In paired comparison, the relative difference was significantly greater for the pen-tablet (p<0.01)., Conclusion: The pen-tablet showed to be the most reproductive and concordant method in the measurement of body vertebral area of fetal lumbosacral spine by 3D ultrasonography using the VCI.

Objectives: The purpose of this study was to determine reference values for the length and area of the fetal corpus callosum between 20 and 33 weeks' gestation using 3-dimensional sonography., Methods: A cross-sectional study was performed in 293 healthy pregnant women between 20 and 33 weeks' gestation. The length and area of the corpus callosum were obtained via the transfontal view with the metopic suture as an acoustic window using 3-dimensional sonographic aquisitions. Linear and weighted polynomial regression models were used, which were adjusted by residual analysis and the R(2) determination coefficient. Intraobserver and interobserver reproducibilities were analyzed by an intraclass correlation coefficient., Results: The mean corpus callosum length ± SD varied from 19.52 ± 2.24 to 40.36 ± 2.87 mm, whereas the mean area varied from 0.44 ± 0.11 to 1.47 ± 0.21 cm(2) at 20 and 33 weeks, respectively. The length and area were highly correlated with gestational age: corpus callosum length = -52.41 + 4.71 × gestational age - 0.06 × gestational age(2) (R(2) = 0.868); and corpus callosum area = -2.47 + 0.16 × gestational age - 0.000037 × gestational age(2) (R(2) = 0.765). The intraobserver and interobserver reproducibilities were excellent, with intraclass correlation coefficients of 0.98 and 0.94 for the length and 0.99 and 0.90 for the area, respectively., Conclusions: Reference values for the length and the area of the fetal corpus callosum between 20 and 33 weeks' gestation were determined with high reproducibility.

Background: Early detection of septal changes such as septal hypertrophy commonly present in fetuses of diabetic mothers would help reduce the high rates of infant mortality., Objective: Determine reference ranges for the fetal ventricular septal area through three-dimensional ultrasound (US3D) using the STIC method (Spatio-Temporal Image Correlation)., Methods: We conducted a cross-sectional study with 69 pregnant women between the 18th and 33rd weeks of pregnancy. We used as a reference the four-chamber plane with the ROI (Region of Interest) positioned from the ventricles; the septum area were manually marked. To assess the correlation of the interventricular septum area with gestational age (GA), we constructed scatter plots and calculated Pearson's correlation coefficient (r), and the adjustment was performed by the coefficient of determination (R²). We calculated averages, medians, standard deviations (sd), as well as maximum and minimum values. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC). The interventricular septum thickness was measured and it was correlated with gestational age and the septal area rendered in 52 patients using the ICC., Results: The interventricular septum area was highly correlated with gestational age (r = 0.81), and the average increased from 0.47 cm² in the 18th week to 2.42 cm² in the 33rd of gestation. The intraobserver reproducibility was excellent with ICC = 0.994. No significant correlation was observed between the interventricular septum measurement and the GA (R² = 0.200), as well as there was no correlation with the septal area rendered with ICC = 0.150., Conclusion: Reference intervals for the interventricular septum area between the 18th and the 33rd pregnancy week were determined to be highly reproducible.

Purpose: to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method., Methods: a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p<0.05. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC) and the Bland-Altman graph., Results: the mitral and tricuspid valve areas were correlated to the gestational age (r=0.80 for the tricuspid and r=0.79 for the mitral valve) and the mean value of the tricuspid and mitral valves increased from 0.22 ± 0.10 cm² and 0.23 ± 0.10 cm² on the 18th week to 0.92 ± 0.29 cm² and 1.08 ± 0.41 cm² on the 33rd of pregnancy, respectively. The intraobserver reproducibility resulted in an ICC=0.993 (95%CI 0.987; 0.996) and the mean difference was 0.01 cm² (SD ± 0.2 cm² and CI95% ± 0.4 cm²)., Conclusion: reference intervals for the areas of the mitral and tricuspid valve between the 18th and the 33rd week of gestation were determined and proved to be highly reproducible.

We assessed the vascular indices of the anterior territory of the middle cerebral artery (MCA) in normal pregnancies using 3-D power Doppler (3DPD). A cross-sectional study was carried out on 90 normal pregnancies between 24 and 35 weeks. All examinations were performed by a single operator using a volumetric transducer. The anterior territory of the MCA was scanned and the volumes were captured using 3DPD. The sphere mode of the VOCAL program was used to calculate the following vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). Models of polynomial regression and Pearson's correlation coefficient were used to evaluate the correlation between gestational age (GA) and the vascular indices. The 3DPD vascular indices had a low correlation with gestational age (VI - r = 0.324, p = 0.002; FI - r = 0.375, p < 0.001; VFI - r = 0.374, p < 0.001). There was a low correlation between GA and the 3DPD vascular indices of the anterior territory of the MCA.

Objective: To establish normative data for the peak systolic velocity of the middle cerebral artery (MCA-PSV) of fetuses in the second half of pregnancy using multiples of the median and percentile reference range., Methods: A cross-sectional study was performed in 90 healthy fetuses at between 23 and 35 weeks of gestation. A bi-dimensional axial scan of the brain, including the thalami and cavitas septi pellucidi was obtained. The circle of Willis was visualized using color flow mapping. Pulsed-wave Doppler velocimetry of the MCA was performed close to the artery's origin, with a beam-vessel angle below 20 degrees . A table with the multiples of the median (MoM) of the MCA-PSV for each gestational age was generated and Pearson's correlation coefficient (r) was calculated. Regression modeling across gestational age was performed to obtain the reference values., Results: There was a strong correlation between the MCA-PVS and gestational age (r = 0.70; p < 0.001). Values for the MCA-PSV for the following MoM were calculated: 1.0, 1.29, 1.50, and 1.55. The MCA-PSV 2.5(th) and 97.5(th) centiles ranged from 24.33 cm(2)/s to 78.36 cm(2)/s, respectively, between weeks 23 and 35., Conclusions: A nomogram for the fetal MCA-PSV during the second half of pregnancy was generated.