Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2019 | October-December | Volume 13 | Issue 4

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Nobuhiro Mori, Kenta Yamamoto, Uiko Hanaoka

SlowflowHD for Detection of Small Fetal Peripheral Vasculature

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:4] [Pages No:155 - 158]

Keywords: Color Doppler, Fetus, SlowflowHD, Small peripheral vessels.

   DOI: 10.5005/jp-journals-10009-1603  |  Open Access |  How to cite  | 


SlowflowHD (GE Voluson E10, BT 19) is a new Doppler technology, which can visualize blood flow of smaller vessels in the branching vascular bed of the fetus and placenta. Its main characteristics are a high-display frame-rate, high-line density (high-resolution), and good sensitivity. In this article, we present our first experience of using SlowflowHD for the detection of small fetal peripheral vasculature.



Vlatko Silobrčić

Evaluation of the Quality of Scientific Research

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:3] [Pages No:159 - 161]

   DOI: 10.5005/jp-journals-10009-1602  |  Open Access |  How to cite  | 



Admir Rama, Amela Muftic

Doppler Sonography of Uterine Arteries in Pregnancy as a Marker of Preeclampsia

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:7] [Pages No:162 - 168]

Keywords: Doppler sonography, Notch, Preeclampsia.

   DOI: 10.5005/jp-journals-10009-1611  |  Open Access |  How to cite  | 


Introduction: Preeclampsia is the cause of increased morbidity in mothers, and mortality and morbidity of both mothers and fetuses and newborns. The pathological process is already complete when the symptoms occur, and nothing concrete can be done to stop the process. Early identification of women at risk of developing preeclampsia is a key goal of antenatal care. Alongside chemical tests, Doppler sonography of the uterine arteries plays a major role in the prediction of preeclampsia. Aims: To establish the probability of resistance to blood flow in the uterine arteries and the existence of notching in the control and test groups. Materials and methods: The study comprised 60 subjects in the second trimester of pregnancy who were going for check-ups during their pregnancy or had been hospitalized at the Maternity Clinic of Sarajevo UCC. All the subjects were divided into two groups, a control and a test group, in relation to the presence of pathological blood flow in the uterine arteries. As well as ultrasound results, the patients also provided an exhaustive history about their previous pregnancies, if any, and any relevant laboratory results. Results: A statistically significant difference was found in the average values of systolic and diastolic pressure during pregnancy between the control and the test group (p = 0.001). From an analysis of the resistance to blood flow in the uterine arteries in the control and test groups, we concluded that the flow on the side with the placenta and on the side without the placenta were physiological over five measurements in the control group of subjects. In the test group the largest number of cases of pathological flow were recorded, and there was also notching. Of the 21 subjects with a diagnosis of preeclampsia, there was notching in 10. Conclusion: Doppler sonography in the second trimester of pregnancy is a good prognostic marker for early discovery of preeclampsia.



Marisa Borenstein Guelman, Guillermo Azumendi Pérez

Application of Three-dimensional Ultrasound in the First Trimester

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:12] [Pages No:169 - 180]

Keywords: Embryo, Fetus, First-trimester scan, Pregnancy, Three-dimensional ultrasonography.

   DOI: 10.5005/jp-journals-10009-1604  |  Open Access |  How to cite  | 


The first trimester of pregnancy is the most critical moment for the embryo and fetal development in terms of rapid changes and modification of its internal and external appearance. The modern ultrasound equipment enables us to identify some of these changes as early as 5–7 weeks after the last menstrual period (LMP). The relevance of 3D ultrasound (3D US) in the detection and demonstration of fetal abnormalities has already been proven. Some of the 3D/4D tools have shown some benefits compared to the 2D US when a malformation is present. The 3D images are usually clearer for parents to understand the problem or the normality of the small fetus. There are five main aspects of the 3D/4D US to mention, which are relevant during the first trimester of pregnancy: (1) the multiplanar approach of the embryo and the fetus; (2) the ability to obtain planes that are not accessible with 2D US; (3) the possibility to do an off-line analysis of acquired 3D/4D volumes and telemedicine; (4) the images are usually easier to interpret for parents when displayed with the surface mode; and (5) the increasing amount of tools available to process fetal images and perform different measurements. Answer to the question is it essential to have a 3D/4D ultrasound machine in everyday practice to carry out a first-trimester scan is obviously negative; however, as most of the practitioners do have one nowadays, it is important to point out its benefits and limitations.



Ulrich Honemeyer

Three-dimensional Ultrasound Imaging in the Diagnosis of Ectopic Pregnancy

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:12] [Pages No:181 - 192]

Keywords: 3D ultrasound, Color/power Doppler, Ectopic pregnancy, Tomographic ultrasound imaging.

   DOI: 10.5005/jp-journals-10009-1605  |  Open Access |  How to cite  | 


Morbidity and mortality of ectopic pregnancy (EP) have been drastically reduced since the first successful surgical removal of a fallopian tube EP in 1884 by Tait. Diagnosis and treatment were revolutionized by the introduction of quantitative serum beta hCG essay, high frequency transvaginal ultrasound (TVS), laparoscopic surgery, and interventional radiology with uterine artery embolization (UAE). In this paper, the focus will be on TVS diagnosis of EP in various locations. With two-dimensional (2D) color Doppler TVS having established itself as state-of-the-art diagnostic tool for EP, it will be discussed whether the additional use of 3-dimensional (3D) TVS facilitates the diagnosis of EP.



Sonal Panchal, Chaitanya Nagori

Three-dimensional Ultrasound in Infertility and Ectopic Pregnancy

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:23] [Pages No:193 - 215]

Keywords: Ectopic pregnancy, Female infertility, Three-dimensional ultrasonography, Uterine congenital malformations.

   DOI: 10.5005/jp-journals-10009-1609  |  Open Access |  How to cite  | 


Three-dimensional ultrasound (3D US) is now a well-developed technology; and it has proved its superiority over the B mode US in several applications. Infertility may be due to female factor as well as male factor (40–45%). For the assessment of the female, transvaginal scan is the scanning method of choice and the first-line investigation. Adding dynamic examination, Doppler and 3D US markedly increases the information available. Three-dimensional US can be used for assessment of uterine congenital anomalies, intrauterine pathologies, adnexal lesions, tubal patency assessment, polycystic ovaries, ovarian follicular monitoring, and endometrial receptivity assessment. Three-dimensional US can better demonstrate the uterine lesions, such as polyps, endometrial synechiae, and fibroids. Better delineation of endometriomyometrial junction helps diagnosis of adenomyosis comparable to MRI. Tubal assessment can be made more effective by adding 3D to hysterosalpingocontrast sonography. Three-dimensional US is accurate for volume assessment for both follicles and endometrium, which are much more reliable parameters than follicular diameter or endometrial thickness. The presence of cumulus, the presence of which can be confirmed by 3D US more easily than with B mode and increases the surety of the presence of a mature ova in the follicle. Three-dimensional power Doppler gives an idea about global vascularity of the follicle and endometrium. However, larger studies are still needed to establish more precise values of 3D ultrasonography in the assessment of female infertility.



Ebru Tarım, Cihat Sen

Three-dimensional Ultrasonographic Evaluation of the Fetal Posterior Fossa

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:4] [Pages No:216 - 219]

Keywords: Congenital malformations, Fetal posterior fossa, Three-dimensional ultrasonography.

   DOI: 10.5005/jp-journals-10009-1607  |  Open Access |  How to cite  | 


Posterior fossa malformations can be considered as very frequent brain anomalies. Irrespective of the rapid development of fetal imaging, the frequency of both false-negative and false-positive diagnoses of posterior fossa anomalies did not change, making the diagnosis difficult. Fetal posterior fossa abnormalities may be broadly divided into hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia, and cystic posterior fossa anomalies, and cranial vault malformations or Chiari malformations. Categorization of posterior fossa anomalies is still controversial and there is no uniform approach. Multidimensional mode in fetal neurosonography by 3D probes has several advantages over standard 2D probes. Unlimited offline analysis by using three orthogonal planes of the fetal brain, tomographic ultrasound imaging (TUI), and volume contrast imaging (VCI) may be obtained by a single 3D acquired data. These neuroimaging modes allow obtaining more precise information on fetal posterior fossa and the results are comparable to those obtained with fetal magnetic resonance imaging (MRI). Three-dimensional ultrasonography is an invaluable instrument for differential diagnosis of posterior fossa anomalies. Transabdominal or transvaginal 3D ultrasonography allows thorough assessment of the complex anatomic structures of the posterior fossa and improves diagnostic accuracy and diagnostic confidence having a positive clinical effect in most of the cases.



Sanja Plavsic Kupesic

Fibroids and Infertility: The Added Value of Three-dimensional Ultrasound

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:9] [Pages No:220 - 228]

Keywords: Infertility, Three-dimensional power Doppler, Three-dimensional ultrasound, Uterine fibroids.

   DOI: 10.5005/jp-journals-10009-1606  |  Open Access |  How to cite  | 


Uterine fibroids, benign monoclonal tumors of the uterine smooth muscle cells and fibrous connective tissue, are the most common tumors of the female pelvis, occurring in about 20–30% of women of reproductive age. The cumulative rate of uterine fibroids increases with age, with a tendency of slower increase at older reproductive age. Fibroids may be of various sizes, single or multiple, and are described based on their relationship to the uterine cavity. Those located within the myometrium are called intramural and are considered the most common, occurring in about 58–79% of all patients, while the other locations are submucous which eventually may become intracavitary and subserous fibroids. According to the American Society for Reproductive Medicine (ASRM), uterine myomas are associated with infertility in 5–10% of cases and may be responsible for 2–3% of infertility cases. The growth of fibroids during pregnancy cannot be predicted. Majority of the fibroids’ growth occurred in the first trimester. Imaging techniques used for the diagnosis of uterine fibroids include transabdominal and transvaginal two-dimensional (2D) and three-dimensional (3D) ultrasound, saline infusion sonography (SIS), and magnetic resonance imaging (MRI). Sonographic assessment of the uterine fibroids includes determination of their number, location, echotexture, and size, by measuring the three maximum diameters (length, width, and height). Serial examinations are necessary to document the interval growth and change in morphology. Combining the advantages of multiple imaging modalities: ultrasound as a noninvasive, nonirradiation, and inexpensive method, and volume acquisition known from CT and MR imaging technologies, 3D ultrasound and 3D power Doppler angiography have become valuable diagnostic tools for the assessment of uterine fibroids. By providing multiplanar imaging, 3D ultrasound not only gives an additional dimension to the uterine scan but also provides a similar quality and less expensive alternative to MRI. Automated volume acquisition minimizes the subjectivity of the ultrasound assessment and can be used for retrospective analysis.



Juan L Alcázar

Three-/Four-dimensional Ultrasound for the Assessment of Ovarian Tumors

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:7] [Pages No:229 - 235]

Keywords: Four-dimensional ultrasonography, Ovarian neoplasms, Three-dimensional ultrasonography.

   DOI: 10.5005/jp-journals-10009-1608  |  Open Access |  How to cite  | 


Background: Adnexal masses are a common clinical problem in gynecology. Most adnexal masses are benign, but few of them are malignant. An accurate diagnosis is essential for adequate management. There is a possibility to make a distinction between benign and malignant adnexal masses using two-dimensional grayscale ultrasound (2D-US) and color Doppler ultrasound, which are the best imaging techniques for that purpose. Objective: To review current state-of-art of 3D/4D ultrasound in assessing ovarian masses. Materials and methods: Narrative review of literature published from 1995 to 2017 using 3D/4D ultrasound for assessing adnexal masses masses. Results: Three-dimensional ultrasound (3D-US) has become a routine practice in many gynecologic ultrasound laboratories because it overcomes the limitations of two-dimensional ultrasound (2D-US). This technique allows a surface rendering of the internal aspect of the cyst's wall. It can also present the masses in new different ways, such as “inversion mode” or “silhouette mode” or it can represent the vascular tree of the tumor using a 3D reconstruction, or even allowing a unique way for estimating the amount of vessels within the tumor or a part of the tumor. The reproducibility of 3D-US performed by different sonographers has been assessed in several studies. All of them have found that this technique is reproducible among different observers. The main limitations of all the studies are a few cases compared to the high prevalence of malignancies. Conclusion: 3D-US probably have better diagnostic performance than 2D-US assessing malignancies in adnexal masses. However, better-designed studies are needed to draw definitive conclusions.



Marianna Theodora

Early Pregnancy Scanning: Step-by-Step Overview

[Year:2019] [Month:October-December] [Volume:13] [Number:4] [Pages:7] [Pages No:236 - 242]

Keywords: Early pregnancy, Miscarriage, Ultrasound, Yolk sac.

   DOI: 10.5005/jp-journals-10009-1610  |  Open Access |  How to cite  | 


Ultrasound is an essential tool for the evaluation of early pregnancy structures. The main method used during early pregnancy is transvaginal ultrasonography, in order to evaluate the course of the pregnancy during the first weeks. Although our knowledge on ultrasound has increased significantly during the last few years, still early pregnancy remains an area with not so well understood findings and structures. In this article, we will review the timeline of the first visualization of the most significant figures, which are expected to be present throughout the first trimester in a normally developing pregnancy. In addition, the suspicious and the diagnostic ultrasound findings of early pregnancy failure will be presented. We will highlight that the diagnosis of early pregnancy failure must be set by following the cutoff values which are established in order to eliminate the possibility of a false positive diagnosis and to avoid any harmful intervention in a viable pregnancy. Finally, we will denote the prognostic predictive value of evaluation of fetal heart rate and subchorionic hematomas presence in early pregnancy. Aim of this article is to review the literature regarding the diagnosis and prognosis of early pregnancies, improve clinicians’ knowledge on this issue, and of course to help avoid or decrease possible misdiagnosis.


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