Ischiopagus Conjoined Twins with Dividing Membrane and Two Yolk Sacs at 9 Weeks of Gestation: HDlive Silhouette Findings
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:2] [Pages No:175 - 176]
DOI: 10.5005/jp-journals-10009-1656 | Open Access | How to cite |
We present a case of ischiopagus conjoined twins with a dividing membrane and two yolk sacs at 9 weeks and 1 day of gestation. Two-dimensional sonography clearly showed ischiopagus conjoined twins with a dividing membrane. Color Doppler revealed vascular communication between the conjoined twins in the pubic area and one umbilical cord. HDlive Silhouette clearly depicted ischiopagus conjoined twins with two yolk sacs. To the best of our knowledge, this is the first reported case of ischiopagus conjoined twins with a dividing membrane and two yolk sacs described early in the first trimester of pregnancy.
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:1] [Pages No:177 - 177]
DOI: 10.5005/jp-journals-10009-1651 | Open Access | How to cite |
Fetal Face Malformations in Ultrasound
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:17] [Pages No:178 - 194]
DOI: 10.5005/jp-journals-10009-1660 | Open Access | How to cite |
Late-onset Fetal Growth Restriction: Or Just Ultrasound?
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:3] [Pages No:195 - 197]
DOI: 10.5005/jp-journals-10009-1645 | Open Access | How to cite |
Late-onset fetal growth restriction (FGR) is still a diagnostic challenge. Current criteria are based on ultrasonography in which biometric measurements and Doppler flows are used. Differentiation between the constitutional low birth weight and FGR is still being explored. Diagnostic methods that clearly indicate a group of fetuses with FGR may prove to be key in developing algorithms.
Genetic Screening Tests and Prenatal Diagnosis for Aneuploidies
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:6] [Pages No:198 - 203]
DOI: 10.5005/jp-journals-10009-1661 | Open Access | How to cite |
The genetic screening and prenatal diagnosis panorama have been profoundly modified in the last 30 years. This study analyzes the changes on international level and shares the experience of our maternal-fetal-perinatal medicine center at the Microcitemico Hospital, Cagliari. We observed the evolution of screening tests for fetal aneuploidies. There was an overall reduction of invasive prenatal procedures, probably due to denatality, the innovations in ultrasound imaging technology, and the introduction of noninvasive prenatal testing. Furthermore, we reported the decrease of amniocentesis as compared to chorionic villous sampling (CVS) and the decline of fetal loss rates following both of these procedures. The demand for training fellows in invasive prenatal procedures and especially in CVS is continuously increasing.
Interventions for Fetal Lower Urinary Tract Obstruction
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:4] [Pages No:204 - 207]
DOI: 10.5005/jp-journals-10009-1646 | Open Access | How to cite |
Aims and objectives: To review intervention methods for fetal lower urinary tract obstruction (LUTO). Background: Lower urinary tract obstruction is a group of congenital anomalies present in 2 to 3/10,000 live births and may be associated with 45 to 100% perinatal mortality. Prenatal ultrasound is the diagnostic tool for LUTO and also can be helpful for the selection of appropriate cases for antenatal treatment. Common ultrasonographic symptoms are distended bladder (megacystis), oligo/anhydramnios, hydronephrosis, and renal parenchymal changes especially in severe forms of LUTO. Recent studies in this field reported clinical scoring systems for LUTO instead of classic antenatal ultrasonographic criteria which allows for appropriate counseling and treatment of cases. Monitoring with serial ultrasonographic series, termination of pregnancy for selected cases, and prenatal fetal intervention are among management options of LUTO. In utero treatment is based on the possibility of removing the obstruction in the urethra and preventing renal damage as well as pulmonary hypoplasia by restoring the amniotic fluid volume. Results: Currently, vesicoamniotic shunting (VAS) and fetal cystoscopy are main choices for fetal therapy in LUTO. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated that these procedures may possibly improve perinatal survival. Conclusion: Future prospective trials may improve the efficacy of diagnostic criteria and timing for procedures and may provide us with more information about effect of LUTO on long-term renal performance during postnatal period. Clinical significance: Diagnosing fetal LUTO and treating accordingly may improve postnatal renal functions and survival of the baby.
Interhemispheric Supratentorial Cysts
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:6] [Pages No:208 - 213]
DOI: 10.5005/jp-journals-10009-1655 | Open Access | How to cite |
Interhemispheric supratentorial cystic-like fluid collections may be occasional findings occurring during the routine second trimester ultrasound screening. The correct diagnosis of the origin of the cyst is necessary for an adequate counseling: In most cases, the cyst is a benign finding but sometimes it can be the sign of a serious abnormality with neurological sequelae. They may be located from the anterior to the posterior aspect of the brain in three regions: (1) the area of the anterior complex [cavum septi pellucidi (CSP)]/cavum vergae (CV), frontal horns of the lateral ventricles, genu of the corpus callosum (GCC); (2) the intermediate zone (thalami and third ventricle); (3) the area of the posterior complex [arachnoidal space delimited by the medial walls of the occipital lobes and the splenium of the corpus callosum (CC)]. Cysts of the anterior complex include dilatation of the CSP/CV and agenesis of septum pellucidum (ASP). A cystic structure in the intermediate zone may be due to dilatation of the third ventricle in case of aqueductal stenosis (AS) or agenesis of the corpus callosum (ACC). Interhemispheric cysts located in the area of the posterior complex are arachnoidal cysts originating from the cavum veli interpositi, the quadrigeminal and suprasellar cisterns. In order to define the correct location and consequent clinical significance of the cyst, a complete neurosonogram is needed with the midsagittal view being the most informative plane.
Ultrasound and Biologic Therapy in Reproductive and Perinatal Medicine
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:6] [Pages No:214 - 219]
DOI: 10.5005/jp-journals-10009-1647 | Open Access | How to cite |
New biotechnology procedures have been introduced to the field of reproductive and perinatal medicine to find solutions for the successful reproduction, as well as disturbances responsible for maternal and perinatal morbidity. Ultrasound plays a crucial role in the early detection of reproductive disorders and perinatal medicine, where biological therapies can be possibly applied. Besides, these techniques require precise monitoring of the application of the biological agent, for which ultrasound is a sovereign method. The use of autologous sources, such as platelet-rich plasma and bone marrow-derived stem cells, provides a wide range of therapeutic strategies for gonadal failure and endometrium therapy. Stem cells from amniotic fluid could be used as the sources for direct fetal treatment in different fetal disorders (neurological disorders, the intrauterine growth restriction). Maternal complications, such as premature rupture of the amniotic sac and disturbed placental adherence, are being successfully treated with the use of biological autologous fibrin tissue adhesives. Postpartum complications related to the change of the pelvic floor could be prevented by the peripartal local application of growth factors and/or stem cells. Subcellular therapies, as microvesicles/exosomes are membrane-bound biological nanoparticles secreted from stem cells. These particles are variable source that could act as another source of factors that could affect molecular cascades, emerging as a new diagnostic and therapeutic tool in reproductive and perinatal medicine.
Polish Women's Preferred Choices for Prenatal Screening
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:2] [Pages No:220 - 221]
DOI: 10.5005/jp-journals-10009-1648 | Open Access | How to cite |
Prenatal screening is a dynamically developing branch of perinatal medicine. The multitude of possible options of prenatal testing enables more and more accurate diagnosis. Also, it makes prenatal counseling more difficult and challenging for physicians and may be incomprehensible for patients. There is no doubt prenatal screening should be offered to all pregnant women. There are a few scientific studies analyzing patients’ approach and attitude to prenatal screening. In Poland, a country considered conservative and Catholic, Polish women were asked in Kosinski et al. research study about their opinion and expectations towards prenatal diagnostic. As it turned out, almost all Polish women expect prenatal screening and would want to be informed about genetic and structural abnormalities. Over half of the women would consider termination of pregnancy if severe abnormality is detected. Willingness to be informed about genetic disorder and fetal abnormalities increases with maternal age and average household income and depends on severity of abnormality.
Basic Fetal Heart Examination: The Protocol at 18–22 Weeks and Literature Review
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:4] [Pages No:222 - 225]
DOI: 10.5005/jp-journals-10009-1657 | Open Access | How to cite |
Congenital heart defects (CHDs) remain the most common birth defect in live births and are the main factors of infant morbidity and mortality in the developed countries. Rapid development of technology over the past decade has led to a significant change in survival rates of infants with CHDs. Early diagnosis and appropriate CHD treatment are essential for the improvement of perinatal outcome. Each year in Poland, we observe dynamic progress in the use of ultrasound prenatal techniques, which offers pregnant women a high-level examination. Basic screening examinations are offered for majority of women, as well as, for selected cases who demand more advanced and extensive ultrasound including fetal echocardiography. The aim of this paper is to summarize the recent knowledge in fetal screening ultrasound of the heart as a standard in the daily practice of every obstetrician-gynecologist.
What to Look for in the Ultrasound Examination of Multiple Pregnancy?
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:5] [Pages No:226 - 230]
DOI: 10.5005/jp-journals-10009-1653 | Open Access | How to cite |
Since multiple pregnancies are of higher perinatal risk to diminish the rate of complications and stillbirth, the proper ultrasound management has to be done. Twins differ in zygosity, chorionicity, and amnionicity. Authors summarize how to diagnose the type of pregnancy and its complications in ultrasound examination and what to look for to achieve as much as possible of vital information. Authors propose some general rules for sonographers: • Prenatal US—the same schedule as in singletons for assessment of fetal morphology and markers of genetic abnormalities despite special schedule for twins. • Keep patient aware about the possibility of “vanishing twin.” • Set the chorionicity as early as possible. • Set the amnionicity in the first-trimester scan. • Look for the prognostic signs of twin-to-twin transfusion syndrome (TTTS) in the first- and second-trimester scan. • Monitor the amniotic fluid volume from 16th week gestational age (GA) on. • Monitor the fetal growth from the first-trimester scan on. • Doppler US and growth every 2 weeks in monochorionic (MC) twins or every week if suspicious signs occur from the 16th week of GA on; every 4–6 weeks in DC twins. • Exam the middle cerebral artery-peak systolic velocity (MCA-PSV) in MC from the mid-pregnancy on. • Look for the cervix incompetence and the risk of preterm delivery.
Fetal Heart Assessment during the 13-week Scan
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:6] [Pages No:231 - 236]
DOI: 10.5005/jp-journals-10009-1652 | Open Access | How to cite |
Congenital heart defects (CHD) affect nearly between 6 and 12 per 1000 live births in the general population. The 13-week scan was mainly constructed to perform screening for chromosomal anomalies. Recently there was a strong relation between wide NT and negative ductus venosus (DV) with congenital heart later direct heart examination was achievable at acceptable degree of success and at satisfactory levels during the 13-week scan as part of fetal anatomy check at this age of pregnancy. Early diagnosis of major heart anomalies was done with the application of same principles of examining the heart at 2nd trimester. Most of the literature published recently dealing with fetal anatomy at 13-weeks is mentioning the details of heart examination and how to perform it using all methods available including color Doppler and the results were very satisfactory. The higher the crown-rump length (CRL) the better the ability to visualize the fetal heart in details.
Preeclampsia Prediction and Prophylaxis in Routine First-trimester Screening Services
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:8] [Pages No:237 - 244]
DOI: 10.5005/jp-journals-10009-1654 | Open Access | How to cite |
Prenatal screening confers benefits to the population served by that program. Screening programs that are poorly implemented can also be harmful. This article proposes the practical means to establish a routine clinical service of first-trimester prediction for preterm preeclampsia. A combination of maternal characteristics, mean arterial pressure, uterine artery Doppler, and placental growth factor can identify the majority of preterm (<37 weeks of gestation) preeclampsia with reasonably low false-positive rate. A single visit to an integrated clinic at 11–13 weeks’ gestation also allows for an assessment of the risks for a wider range of pregnancy complications, including common fetal aneuploidies and early-onset fetal growth restriction. Certification and audit of ultrasound operators and laboratories is important to assure the quality of the prenatal screening service. In the context of preeclampsia, the primary aim of such clinic is to identify those that would potentially benefit from prophylactic intervention with aspirin to improve placentation.
What did We Learn from the Structural and Functional Development of Fetal Brain Using Four-dimensional Sonography?
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:17] [Pages No:245 - 261]
DOI: 10.5005/jp-journals-10009-1659 | Open Access | How to cite |
Every human brain is a special, unique, and impressive organ and it does not fail to fascinate us every time with its endless possibilities and adaptation. New technology, such as four-dimensional ultrasound diagnostic devices, has gave us a chance to take a peek into the most complex, incredibly well-organized, and spectacular architecture of formation of fetal brain. Neuroscientists have made incredible discoveries about different structures and regions of the brain, and many elements of brain cognitive functions. However, what remains a great mystery is the interaction of different parts of the brain, in other words, that we are not entirely sure how individual parts of the brain exchange data and how and to what extent each is important and contributes to different patterns of behavior, feelings, or memory. Scientific research toward mapping the brain connections is on the way. Assessing fetal behavior in utero, its motor and cognitive functions, is one of the major challenges in perinatal medicine. Fetal behavior reflects the maturation and integrity of the fetal central nervous system (CNS). Understanding the course and timing of fetal neurodevelopmental events in relation to the development of motor and sensory systems is crucial to determining how environmental influences can affect certain structures as well as functions. With the Kurjak's antenatal neurodevelopmental test (KANET) it is possible, for the first time ever, to evaluate the neurological state of the fetus in real time and to differentiate normal, borderline, and abnormal fetal behavioral patterns. If the KANET score is normal, that is highly predictive of favorable neurodevelopment of the infant. On the other hand, if the KANET score is borderline or abnormal in a high-risk pregnancy, the child's postnatal development may appear abnormal. Thorough postnatal prospective neurodevelopmental (short- and long-term) follow-up of these children is highly recommended.
Effects of Lubricants Used at Speculum Examination on Conventional and ThinPrep Smear Results
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:3] [Pages No:262 - 264]
DOI: 10.5005/jp-journals-10009-1662 | Open Access | How to cite |
Aims and objectives: We conducted a retrospective study to compare the rate of satisfactory conventional and ThinPrep smears with and without lubricant use. Materials and methods: We reviewed smear test results of 5,126 patients retrospectively. Both conventional and ThinPreps were included. Results: Overall, there was no difference between the two groups for satisfactory smear results. There was also no difference between smear groups in postpartum and postmenopausal patients. Lubricant use decreased satisfactory smear rate in ThinPrep smears (81.9% and 85.5%, p = 0.038). When ThinPrep smears were taken without lubricants, a statistically significantly higher rate of cervical dysplasia (2.5% and 3.6%, p = 0.023), nonspecific infection (64.9% and 69.2%, p = 0.001), trichomonas infection (0.3% and 0.9%, p = 0.004), and bacterial vaginosis (2.7% and 5.9%, p = 0.001) were detected. Conclusion: Lubricants affect satisfactory smear results only in ThinPrep smears. Detection of cervical dysplasias, bacterial vaginosis, and trichomonas infections were higher when lubricants were not used.
What is Local and What is Global in the Legal Regulation on Human Reproduction?
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:14] [Pages No:265 - 278]
DOI: 10.5005/jp-journals-10009-1650 | Open Access | How to cite |
Science evolves with new knowledge. Medically assisted procreation (MAP) is one of the scientific fields that has become a revolutionary aid for many couples enabling them to make their beautiful wish to have children come true and achieve the greatest happiness a human being can feel. However, as for any progress, progress of biotechnology and medicine is a relative value if detached from the humane objective. On the one hand, the role of law is to regulate existing relations, and on the other hand to steer social behavior toward a desired goal. When it comes to the MAP treatment, questions arise as to the benefit and harm for the participants in the procedure and third parties. Since law is a system that corresponds to certain categories of values, the question arises whether law regulates, in an acceptable way, everything that is permitted in the MAP procedure and not what is possible in this procedure. New achievements, or everything that MAP can achieve, are not always ethically acceptable. The seriousness of the topic of manipulation with human life, especially its beginning, is shyly and insufficiently recognized in some international documents of global character. Some national legislations, especially in the Member States of the Council of Europe and the European Union, seem to be on the final point of “being overstretched”. European judicature is already facing a major dilemma: Legal protection of the beginning of human life at conception or permissibility of trafficking in unborn children and embryos. The latest case law of the European Court of Human Rights (ECtHR) is not consistent with regard to the children's rights, it is directed toward a more relaxed attitude toward surrogate motherhood, legally the most questionable reproductive procedure, with a (temporarily) permissive attitude toward national legislation. However, one can discern a liberal approach on the horizon, which is already intriguing now and prompts reflection on the future child, his status, rights, benefits, and interests. Similarities and differences at a local level are a result of historical development, the influence of national cultures, and represent a treasure, and not impoverishment. Every future development of legal regulations and medical possibilities has a big question mark placed after the words “value” and “ethical”.
Coronavirus Disease-2019 or the End of a Happy Globalization
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:9] [Pages No:279 - 287]
DOI: 10.5005/jp-journals-10009-1649 | Open Access | How to cite |
Recent catastrophic consequences of coronavirus pandemic stimulate some deeper analysis of present level of globalization, particularly connected with public health problems. One definition of globalization may be that it is the integration of capital, technology, and information across national borders in a way that is creating a single global market and, to some degree, a global village. Besides economic, it includes many different processes such as development of communications systems, the increase in human mobility, the integration of trade and investment across boundaries, the spread of democracy and human rights, the increasing role of nongovernmental organizations in international politics, the growing concern about global epidemics, and ecological matters such as climate change that are happening at the same time and in many cases reinforcing one another. Up till now, in June 2020, there have been over 20,000 published scientific papers on Coronavirus Disease-2019 (COVID-19), which is an unprecedented level of interest in any topic in the entire history of science. Besides the described effect of remdesivir on reducing the length of the illness and the announced research on the effect of dexamethasone on reducing the mortality rate, science has not offered any other news on medication effectiveness so far. After the vaccine's effectiveness in developing antibodies and protecting from COVID-19 is proven, then its safety will need to be proven. Vaccines have to be harmless and their only effect on the organism should be the developing of permanent immunity to the novel coronavirus. However, never have we in history, as humanity, had planned to simultaneously vaccinate 4 or 5 billion people. Most of us welcomed positive globalization process, but with the recent pandemic of corona disease, we are introducing negative part of globalization with many unpredictable developments. Indeed, globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care.
Education, Scholarship, Academic, and Public Services during and after Corona Crisis
[Year:2020] [Month:July-September] [Volume:14] [Number:3] [Pages:8] [Pages No:288 - 295]
DOI: 10.5005/jp-journals-10009-1658 | Open Access | How to cite |
We report on the response to the Coronavirus disease-2019 (COVID-19) crisis by clinical educators, scholars, and researchers in academic medicine. Our review article presents the challenges, advantages, and impact of this long-lasting pandemic emergency on the transition to eLearning, online publishing, and teleconferencing. Advances in educational technology and digital tools allow us to transform our outdated practices by reshaping medical education, scholarship, academic and public services. Educators of the future are not traditional large-group lecturers, small-group proctors, and clinical trainers. They are all of the above, and much more. They are facilitators of the learning processes which occur locally, globally, and virtually. Modern educators and scholars are adaptable to change and are productive and resilient in difficult and uncertain times. They are creators of the learning material that may be used both for online and face-to-face activities. They are effective team players and flexible research collaborators, and are able to see and do things differently. They are open to innovative ideas and willing to share knowledge, experience, and expertise with their peers and learners through different types of academic and public services. Step-by-step instructions for organization of teleconferences provided in our article may serve as a model for academic health science institutions and organizations for rapid transition to online academic services.