Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Volume 16, Number 3, July-September 2022
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PICTURE OF THE MONTH

Toshiyuki Hata, Tomomi Kawahara, Miyu Konishi, Aya Koyanagi, Aya Itoh, Riko Takayoshi, Takahito Miyake

Spontaneous Resolution of Vasa Previa and a Placental Shelf Detected at 19 Weeks of Gestation

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:3] [Pages No:171 - 173]

Keywords: Placental shelf, Second trimester, Spontaneous resolution, Vasa previa

   DOI: 10.5005/jp-journals-10009-1941  |  Open Access |  How to cite  | 

Abstract

Objective: The spontaneous resolution of vasa previa sonographically diagnosed mid-gestation has been reported. We herein describe a case of the spontaneous resolution of vasa previa and a placental shelf (PS), which were identified at a gestational age of 19 weeks and 4 days. Case description: A 26-year-old pregnant Japanese woman, gravida 4, para 1 (G4, P1), underwent a routine second-trimester fetal ultrasound (US) scan at 19 weeks and 4 days of gestation. Fetal biometry was consistent with the corresponding gestational age, and there was no fetal abnormality. Transvaginal two-dimensional sonography (2D-TVS) showed one small tubular structure and a PS at the periphery of a low-lying posterior placenta. This structure was identified as a small blood vessel in close proximity to the internal cervical ostium (os) on color Doppler. Using pulsed Doppler, this vessel was documented as an artery with arterial blood flow consistent with the fetal heart rate. However, the spontaneous resolution of vasa previa was confirmed 4 weeks later. Conclusion: To the best of our knowledge, this is the first case report of vasa previa and a PS that was diagnosed mid-gestation and spontaneously resolved with advancing gestation. Serial TVS examinations need to be mandatory for cases of mid-gestation vasa previa.

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ORIGINAL RESEARCH ARTICLE

Suchandana Dasgupta, Pratima Mittal, Rekha Bharti, Megha Mittal, Divya Pandey, Jyotsna Suri

Fetal Head–Perineum Distance on Transperineal Ultrasound as Predictor of Vaginal Delivery in Term Nulliparous Women Undergoing Induction of Labor

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:7] [Pages No:174 - 180]

Keywords: Head perineal distance, Induction of labor, Predictor of successful vaginal delivery, Transperineal ultrasound

   DOI: 10.5005/jp-journals-10009-1935  |  Open Access |  How to cite  | 

Abstract

Aim: To study the association of fetal head perineum distance (HPD) on transperineal ultrasound (TPU) with the mode of delivery in women undergoing induction of labor (IOL). Materials and methods: Term nulliparous women with singleton pregnancy in cephalic presentation, admitted in the obstetrics wards for IOL, were recruited in the study. After written informed consent, preinduction measurements of fetal HPD on digital vaginal examination (DVE) and TPU were done in 300 women. HPD on TPU was compared with HPD on DVE. Women were followed till delivery, association of HPD on TPU with the mode of delivery was noted, and receiver operating characteristic (ROC) was plotted for successful IOL. Results: For successful vaginal delivery, the ROC cutoff for HPD on TPU was ≤4.39 cm (95% CI 0.860–0.931, p < 0.0001) with sensitivity, specificity, positive and negative predictive value, and likelihood ratio of 97.76, 75.32, 92, 92.1, and 3.96, respectively. HPD on TPU showed significant difference but good positive correlation with HPD on DVE (r = 0.886; 95% CI 0.859–0.908, p < 0.001). With every centimeter increase in the HPD from 4.39 cm, the likelihood of cesarean delivery increased by 47%. On multivariate analysis, HPD measured by TPU was found to be the most significant independent predictor of risk of cesarean delivery, p < 0.0001. Conclusion: Fetal HPD on TPU in term nulliparous women undergoing IOL is a good predictor of vaginal delivery, and every centimeter increase in the HPD from 4.39 cm increases the risk of cesarean delivery by 47%. Clinical significance: Fetal head perineal distance by TPU can be used for counseling primigravida regarding the outcome of IOL.

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ORIGINAL RESEARCH ARTICLE

Amandeep Singh, Parmeet Kaur, Ramanjit Kaur, Gursangeet Singh, Guneet Awal, Pavneet Kaur

Reference Values of Ductus Venosus in First and Second Trimester in Northern Indian Population: An Observational Study in Tertiary Care Center

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:6] [Pages No:181 - 186]

Keywords: Ductus venosus blood flow velocimetry, First trimester and second trimester, Northern India

   DOI: 10.5005/jp-journals-10009-1938  |  Open Access |  How to cite  | 

Abstract

Background: The ductus venosus (DV) can be easily identified by color Doppler mapping in the first and second trimesters. Higher values of DV parameters associated with an increased risk of congenital abnormalities have been established in recent times, thus making it important for continuous monitoring of DV. Aim: The purpose of this study was to put normal reference values of duct venosus in normal gestation during the first and second trimesters. Materials and methods: A cross-sectional study was performed on 400 consecutive pregnant patients between 10 and 24 weeks of gestation. The reference value of DV length, DV area, S wave velocity, A wave velocity, pulsatility index (PI), and resistive index (RI) were calculated. Results: The DV length ranged from 0.96 to 1.23 cm in the first trimester and 0.96 to 1.62 cm in the second trimester, respectively. The range of DV area was found between 0.07–0.15 cm2 and 0.07–0.17 cm2 in the first and in the second trimester, respectively. PI and RI ranged between 0.82–1.40 and 0.62–0.85 in the first trimester and 0.74–1.16 and 0.55–0.77 in the second trimester, respectively. S and A wave velocities ranged between 11.17–69.66 cm/second and 1.61–25.29 in the first trimester of pregnancy. The range of S and A wave velocities was between 13.78–97.11 cm/second and 2.96–49.42 cm/second in the second trimester, respectively. Conclusion: We sought to establish a reference range based on the population's percentile module to ease the process of fetal follow-up, especially in high-risk pregnancies and suspicion of chromosomal or congenital anomalies.

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REVIEW ARTICLE

Helena Dukić

Music, Ultrasound, and Artificial Intelligence: Recent Advances and Future Challenges

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:5] [Pages No:187 - 191]

Keywords: 4D ultrasound, Artificial intelligence, Fetal emotions, Fetal hearing, Music

   DOI: 10.5005/jp-journals-10009-1933  |  Open Access |  How to cite  | 

Abstract

Our emotional connection to music is apparent in all living societies and cultures and has as such sparked intrigue regarding its purpose and origin. In recent years, there have been attempts to model and explain our emotional reactions to music. The issue has been approached in two different ways: (1) From a perspective of our prenatal development and early sound perception experiences and (2) From the perspective of artificial intelligence development, recreating the way humans would react to a certain piece of music. Both of these approaches are presented in this paper, along with the possible similarities between the two, as well as the assumed further developments.

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REVIEW ARTICLE

Radu Vladareanu, Costin Berceanu, Razvan Ciortea, Simona Vladareanu

Key Points and Challenges in Monochorionic Twins

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:18] [Pages No:192 - 209]

Keywords: Anastomoses, Chorioamnionicity, Complications, Imbalance, Management, Outcome

   DOI: 10.5005/jp-journals-10009-1942  |  Open Access |  How to cite  | 

Abstract

The frequency of twin gestations has substantially expanded over the past decades, primarily due to maternal age at the time of conception, and the use of assisted reproductive techniques. Twin pregnancies sum up now approximately three percent of all live births. The incidence of monozygotic (MZ) and therefore monochorionic (MC) twins is approximately 1:250 pregnancies. The high risks of monochorionic twins are intensively associated with the angioarchitecture of the common placenta and the presence of interfetal vascular network. Chorionicity is definitely the fundamental element in multiple pregnancy results. Whichever echographic clue suggests the presence of twin gestation, should constitute the investigation of chorionicity a primacy. The proportional rise of the hazard in MC correlated with dichorionic (DC) twins, is of a significance analogous to that of multiple, in comparison with singleton pregnancies. Diagnosing an MC twin pregnancy has essential obstetric significance, part of which impacts the pregnancy and also restrains some therapeutic choices. The aim of this review is to highlight current key points in the diagnosis and management of MC twin pregnancy, on one hand, and also to discuss contemporary challenges regarding this type of multiple pregnancies.

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REVIEW ARTICLE

Kresimir Pavelic, Sandra Kraljevic Pavelic

Genomic Editing, Human Enhancement, and Transhumanism: A Brief Overview

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:12] [Pages No:210 - 221]

Keywords: Designing a baby, Genetical engineering, Genomic editing, Human enhancement, Transhumanism

   DOI: 10.5005/jp-journals-10009-1934  |  Open Access |  How to cite  | 

Abstract

A scientific debate on genetic engineering, human enhancement (HE), and transhumanism has been largely pursued in scientific literature, but so far, the public opinion on this issue has not been properly surveyed or heard. In this article, we accordingly join the debate through presentation and discussion of chosen scientific facts and opinions on genomic editing (GE) along with perspectives and concerns, HE, designing of baby with genetic engineering, transhumanism, and the culture of life. Finally, we are questioning the idea of an indefinitely long lifetime. While significant scientific advancements in the area of genetic engineering and HE are expected in the future, a reasonable approach and caution in the new knowledge and technologies usage and implementation may be strongly advised. Indeed, legal, ethical, and social issues need to be discussed and evaluated in light of novel possibilities to avoid an eventual critical era of human existence.

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REVIEW ARTICLE

Aliyu Labaran Dayyabu

Hemoglobinopathies in Perinatal Medicine: Challenges in Management

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:16] [Pages No:222 - 237]

Keywords: Challenges, Hemoglobinopathies, Management, Medicine, Perinatal

   DOI: 10.5005/jp-journals-10009-1936  |  Open Access |  How to cite  | 

Abstract

Introduction: Hemoglobinopathies are a group of genetic disorders of hemoglobin (Hb) structure or synthesis. They are among the most common inherited diseases. Approximately 7% of the global population is a carrier, and 300,000–500,000 children are born with a severe Hb disorder annually. They are classified according to the impaired globin chains and whether the disorder leads to reduced production of a normal chain or an abnormal tertiary structure of globin chains. There are two types of hemoglobinopathies, sickle cell disease (SCD), and thalassemia. For years, these diseases impair the quality of life of those afflicted. Impairment in the quality of life can be due to the disease, its complications or even as a result of its treatment. Mortality and morbidity from these diseases are staggering, and many of those affected do not survive to adulthood. However, as medical science develops, the etiology and treatment of the disease are now almost completely unraveled. These have enabled the provision of quality care to those affected with concomitant improvement in quality of life and survival for those affected. Those that get pregnant now constitute a high-risk cohort who require meticulous quality prenatal, intrapartum, and postpartum care to survive. Such care is widely available in developed countries; however, in developing countries where the burden of the disease is highest, such care is scarce, and maternal and perinatal morbidity and mortality remain high. Methods: This review is done through extensive literature search from various sources. It first discusses sickle disease and then the thalassemias. Aims: The review is aimed at summarizing the disease and its management in pregnancy with the hope that physicians will use the acquired knowledge of the disease and the various strategies to improve the quality of life and survival of patients and their fetuses in pregnancy and postpartum. Conclusion: Hemoglobinopathies are a group of genetic disorders of hemoglobin (Hb) structure or synthesis. There are two types of hemoglobinopathies, sickle cell disease (SCD), and thalassemia. Mortality and morbidity from these diseases are staggering, and many of those affected do not survive until adulthood. Those that get pregnant now constitute a high-risk cohort who require meticulous quality prenatal, intrapartum, and postpartum care to survive. The aim of the review is to provide current overview of the disease and its management with the hope that physicians will use the knowledge to improve the quality of life and survival of pregnant women afflicted with the disease to go through pregnancy safely.

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REVIEW ARTICLE

Milan Stanojevic, Asim Kurjak

Are Fetus and Neonate the Same Individual in Terms of Behavior?

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:12] [Pages No:238 - 249]

Keywords: Disability evaluation, Fetal movements, Fetal ultrasonography, Neurophysiology

   DOI: 10.5005/jp-journals-10009-1937  |  Open Access |  How to cite  | 

Abstract

The aim of the paper is to present continuity of behavior from prenatal to postnatal life. As the development of the brain is a unique and continuing process throughout gestation and after birth, it is expected that there is also the continuity of fetal and neonatal movements, which are the best functional indicator of the developmental processes of the brain. Although we have very powerful imaging and other methods to find out the consequences of brain damage, there is no doubt that clinical methods like history and clinical assessment are of utmost importance. Cranial ultrasound (US) has been used to determine the type and evolution of brain damage. Magnetic resonance imaging (MRI), functional MRI, and near-infrared spectroscopy (NIRS) of the brain have also been used to detect antenatal, perinatal, and neonatal abnormalities and timing of the damage on the basis of standardized assessment of brain maturation. Besides the structure, it is important to investigate the function of the brain, which can be assessed by observation of general movements (GMs). All endogenously generated movement patterns from the unstimulated central nervous system (CNS) could be observed as early as from 7 to 8 weeks of postmenstrual age, with developing a reach repertoire of movements within the next 2 or 3 weeks, continuing to be present for 5–6 months postnatally. Classical postnatal assessment of GMs is well developed and established, while prenatal assessment needs sophisticated real-time four-dimensional ultrasonographic (4D US) or other technology in order to enable a more precise assessment of GMs’ quality in fetuses. It is being speculated that intrauterine detection of neurological disability would improve the outcome. Although many fetal behavioral studies have been conducted, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve our ability of early detection of brain pathology. Early detection could possibly raise an opportunity to intervene and even prevent the expected damage. Early intervention programs for preterm infants have a positive influence on cognitive outcomes in short to medium term.

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REVIEW ARTICLE

Asim Kurjak, Sonal Panchal

Three-dimensional Ultrasound and Ovarian Cancer

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:9] [Pages No:250 - 258]

Keywords: Ovarian malignancy, Three-dimensional power Doppler of ovary, Three-dimensional ultrasound, Vascular architecture

   DOI: 10.5005/jp-journals-10009-1940  |  Open Access |  How to cite  | 

Abstract

Ovarian malignancies take the highest toll among all gynecological malignancies in developed countries. In 2018, 4.4% of entire cancer-related mortality among women was attributed to ovarian cancer. The reason probably is that its symptoms do not become evident till the tumor invades the surrounding structures or metastasis or ascites develop. A total of 65% of women with ovarian cancers have stage III or IV diseases at diagnosis, with a 5-year survival rate of only 20–30%. Instead, if the disease is diagnosed at stage IA, when the disease is confined only to the ovary, survival rates of as high as 90% can be achieved. Ultrasound (US) is a modality of choice for the primary diagnosis of the lesion as it clearly demonstrates the morphology. Solid tumors cannot grow larger than 2–3 mm in diameter without inducing their own blood supply. Doppler plays a major role in diagnosis because neoangiogenesis is the major feature of malignant lesions. A resistance index (RI) of <0.4 was found to strongly correlate with the malignant nature of the lesion. But an overlap in RI values between benign and malignant lesions is not uncommon. Three-dimensional (3D) is superior in evaluating papillary projections and characteristics of cystic walls, calcifications, and bone densities, identifying the extent of capsular infiltration of tumors, and calculating the volume. Disorganized, randomly dispersed vessels with irregular branching and asymmetrical caliber with microaneurysms (MAs) and arteriovenous (AV) fistulae with dichotomous branching are typical features of malignant vasculature and are best studied on 3D power Doppler (3D-PD). A study by Kurjak et al. showed a qualitative analysis of the tumor vascular architecture added to morphologic parameters and was clinically pertinent, reaching sensitivity, and specificity of 97 and 99%, respectively.

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CASE REPORT

Suhasini Vittal Rao, Akhil M Kulkarni, Mythri Nag, Srinivas Yella

Congenital Epignathus with Transposition of Great Arteries!

[Year:2022] [Month:July-September] [Volume:16] [Number:3] [Pages:4] [Pages No:259 - 262]

Keywords: Airway obstruction, Neonate, Teratoma, Transposition of great vessels

   DOI: 10.5005/jp-journals-10009-1939  |  Open Access |  How to cite  | 

Abstract

Epignathus of a fetus is a rare type of oropharyngeal teratoma rarely reported in the literature, especially from the Indian subcontinent. Antenatal diagnosis of this condition is even rarer. The overall survival rates with these lesions have been between 17 and 87.5%. However, survival in the setting of antenatally diagnosed teratomas has only been described anecdotally. Transposition of the great arteries (TGA) is an isolated abnormality in about 90% of the cases and rarely is associated with extracardiac malformation. Gallbladder duplication resulting in two separate gallbladders is a rare congenital anomaly. We present an unusual case of antenatally diagnosed massive oropharyngeal teratoma, which was associated with transposition of great arteries and duplicated gallbladder. To conclude, the antenatal diagnosis of TGA decides the postnatal outcomes and hence requires planned delivery and further management. A combination of these conditions may cause airway obstruction and respiratory compromise, like in our case, which necessitated termination of pregnancy.

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