Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2020 | October-December | Volume 14 | Issue 4

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Nevena Mahmutbegovic

Like Mother, Like Child: A KANET Analysis on Intrauterine Life

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:2] [Pages No:297 - 298]

   DOI: 10.5005/jp-journals-10009-1663  |  Open Access |  How to cite  | 


The article presents the possibility of using three-dimensional ultrasound in the prenatal period for assessment of fetal neurobehavior during the Kurjak Antenatal Neurodevelopmental Test (KANET). By analyzing fetal movements and structure, invaluable data on neurodevelopment can be obtained. The surprising position of the fetus and its reactions raise many questions about fetal intrauterine life. The aim of this clinical work is the early detection of the existence of neurodevelopment disorders.



Vlatko Silobrčić

Peer Review: A Necessity for Assuring Quality of Scientific Publishing

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:2] [Pages No:299 - 300]

   DOI: 10.5005/jp-journals-10009-1667  |  Open Access |  How to cite  | 



Aliyu Labaran Dayyabu

Global Failure of Leadership and the COVID-19 Pandemic: A Lesson for the World

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:3] [Pages No:301 - 303]

   DOI: 10.5005/jp-journals-10009-1668  |  Open Access |  How to cite  | 


Original Scientific Paper

Asim Kurjak, Raul Moreira Neto, Suada Tinjić, Sonal Panchal, Dorota Bomba Opon, GiGi Selvan, Sertac Esin, Aida Salihagic Kadic, Selma Porovic

A Critical Appraisal of Kurjak Antenatal Neurodevelopmental Test: Five Years of Wide Clinical Use

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:7] [Pages No:304 - 310]

   DOI: 10.5005/jp-journals-10009-1669  |  Open Access |  How to cite  | 


Purpose: To evaluate the results of the Kurjak antenatal neurodevelopmental test (KANET) in multicentric studies. Materials and methods: In KANET, normal, borderline, and abnormal fetuses postnatal development was followed. The Chi-square was considered significant if p < 0.05 was used in the statistical analysis. Specificity, sensitivity, prevalence, positive and negative predictive value, false-positive, and false-negative results were calculated. Results: In 3,709 singleton fetuses, KANET was assessed. Postnatal follow-up was available for 1,556 of 1,573 (42.4%) infants. For 2,136, the data were not available. Interrater reliability (κ coefficient) for low-risk fetuses was between 0.64 and 0.65 (agreement 94.2–97.3%), for high-risk fetuses was between 0.44 and 0.53 (agreement 70.5–78.9%), respectively. Borderline KANET was found in 153 (9.7%), abnormal in 52 (3.3%), both more prevalent in high-risk pregnancies (χ2 = 457.36; df = 2; p < 0.01). Abnormal KANET was connected with severe postnatal developmental delay (χ2 = 315.28; df = 6; p < 0.01). In 47 out of 1,102 children aged 2 years and more, abnormal KANET was found, among them in one with CP. In 1 out of 1,055 children with normal KANET, severe developmental delay was found. The KANET has low sensitivity for detection of developmental delay and CP. The KANET specificity is high for all tested variables, positive predictive value and the false-positive rate are high, the negative predictive value is high (99.77–99.95%), and the false-negative rate is low (0.23–0.05%). Conclusion: With normal KANET, there is a high probability of normal infant development. If the KANET score is borderline or abnormal in high-risk pregnancies, postnatal development may appear abnormal.


Retrospective Study

Daniel Sanin-Ramirez, Maria P Sanin, Federico Moreno, Isabel Carriles, Nabil Manzour, Julio Vara, Juan Luis Alcázar

Angle Measurement of the Papillary Projection in Unilocular-solid Adnexal Cysts as a Predictor of Malignancy: A Three-dimensional Ultrasound Study

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:4] [Pages No:311 - 314]

   DOI: 10.5005/jp-journals-10009-1664  |  Open Access |  How to cite  | 


Aim and objective: To analyze the value of the angle between the papillary projection and the cyst's wall for differentiating between benign and malignant adnexal masses using three-dimensional ultrasound. Materials and methods: Retrospective study between January 2003 and December 2012 including a series of non-consecutive patients diagnosed as having a unilocular-solid mass in ultrasound. Definitive diagnosis was based on a histological result obtained after surgical removal or ultrasonographic follow-up until the disappearance of the mass. In a 3D volume, the angles formed by the solid component and the cyst's wall in both lateral borders were measured in the three planes, obtaining six different angles. The variables analyzed were an average angle, widest angle, narrowest angle, the difference between the widest and narrowest angle, number of obtuse (>90°), and acute (<90°) angles. Results: Eighty-one patients were included. The patient's mean age was 44.2 years. Twenty-four (29.6%) of them were postmenopausal and 57 (70.4%) were premenopausal. The mean average angle, widest angle, narrowest angle, the difference between the widest and narrowest angle, number of obtuse and acute angles in benign masses were 81.5°, 105.3°, 58°, 47.3°, 2.3, and 3.7, respectively. These figures in malignant masses were 75.7°, 103.7°, 49.1°, 54.6, 1°, 1.8, and 4.2, respectively. We did not find statistical significance in any comparison. Conclusion: Measurement of the angles between the solid component and the cyst's wall in unilocular-solid adnexal masses with only one papillary projection is not useful as a predictor of malignancy.



Narendra Malhotra, Sonam R Pandya

Follicle Monitoring and Endometrial Correlation

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:9] [Pages No:315 - 323]

   DOI: 10.5005/jp-journals-10009-1674  |  Open Access |  How to cite  | 


Thirty-percent of female infertility is due to ovulatory dysfunctions. Today ultrasound (transvaginal ultrasound scan + color + 3D) enables us to understand the follicular dynamics during normal and stimulated cycles. In this review paper, we have analyzed folliculogenesis, follicular monitoring, and measuring and have correlated clinically and presented simply the importance of 2D, 3D, color, volume, vocal, and endometrial perfusion.



Giovanni Monni, Federica Murgia, Valentina Corda, K Joseph Hurt, Luigi Atzori

Metabolomics in Prenatal Medicine: The Sardinian Experience

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:3] [Pages No:324 - 326]

   DOI: 10.5005/jp-journals-10009-1670  |  Open Access |  How to cite  | 


In recent years, the holistic view is becoming the dominant perspective for the resolution of medical issues. Metabolomic approaches offer new opportunities to enhance our understanding of fetal biology and the multifactorial impact of perinatal diseases. Although metabolomics in maternal-fetal biology is increasing, it is not yet widely applied in perinatal medicine. Our group has been at the forefront of applying these powerful approaches to understanding pregnancy and fetoplacental development. This review shows our experience about metabolomics studies utilizing chorionic villus and amniocentesis samples obtained in our busy prenatal diagnostic center in Cagliari, Sardinia. The findings suggest that metabolomic approach in perinatal medicine could be helpful in establishing placental/fetal maturity, diagnosing aneuploidy, or identifying early placental dysfunction. Although omics approaches and the network analysis in perinatal physiology hold promise for a new generation of prenatal biomarkers and potential therapeutics, further investigation is need to improve our knowledge and our ability to diagnose and treat diseases of pregnancy.



Morphogenetic and Differentiation Powers of the Human Embryo

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:6] [Pages No:327 - 332]

   DOI: 10.5005/jp-journals-10009-1675  |  Open Access |  How to cite  | 


Aim and objective: The overview of early embryo development was used to introduce the concept of embryo powers, representing the ability of an embryo to exert an action. Materials and methods: A theory-building approach was applied based on the sequence of events during early embryo development. Results: At the beginning of the development as a fertilized zygote, the embryo potential is at its maximum; however, the embryo itself is completely powerless relying on the proteins and structures provided by the maternal genome. The embryo powers originate from its newly activated genome and gradually increase. Their utilization results in the establishing of the infrastructure necessary to create a body plan. Conclusion: The understanding of embryo powers determines the possibilities for medical intervention in the case of “embryo as a patient”. Moreover, these powers are at the core of controversial technologies converting embryos into “embryo as a cure” for regenerative medicine.



Uiko Hanaoka, Mohamed AM AboEllail, Nobuhiro Mori, Megumi Ito

Behavior of the Embryo

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:9] [Pages No:333 - 341]

   DOI: 10.5005/jp-journals-10009-1676  |  Open Access |  How to cite  | 


Background: There have been only a few studies on conventional four-dimensional (4D) ultrasound assessment of embryonic movements early in the first trimester of pregnancy. With the latest 4D ultrasound, the frame rate in clinical examinations is around 7–20 frames per second depending on the size of the region of interest and number of lines employed using a transvaginal probe at 5–8 weeks of gestation. Moreover, HDlive with its adjustable light source and skin-like colors gives the embryo a natural and anatomically realistic appearance. Findings: At 5 weeks of gestation, a small dot-like embryo adjacent to the yolk sac can be noted as a round to oval structure. At 6 weeks of gestation, the embryo is a solid, comma-shaped structure adjacent to the yolk sac, but embryonic movements cannot be identified at this age. At 7 weeks of gestation, embryonic limb movements and a changing body direction can be noted. At 8 weeks of gestation, various types of movements, such as bending of the wrist, lower limb, upper and lower limb, twisting, startle, and general movements, can be recognized. Conclusion: New embryonic behavioral functions will be identified early in the first trimester of pregnancy using 4D ultrasound. Studies on embryonic behavior will help elucidate the functioning of the embryonic central nervous system, and help shed light on new areas of embryonic development.



Takahiro Ohkura, Yasuo Nakahara

Fetal Intra-abdominal Umbilical Vein Varix Assessed by the Novel Doppler Ultrasound

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:4] [Pages No:342 - 345]

   DOI: 10.5005/jp-journals-10009-1672  |  Open Access |  How to cite  | 


We present two cases of fetal intra-abdominal umbilical vein varix (FIUVV) assessed using Radiant Flow, HDlive Flow, and SlowflowHD. In the first case, FIUVV may have been caused by a persistent right umbilical vein, and it may have been due to umbilical ring contracture in the second case. These causes were suspected by the novel Doppler ultrasound. These novel Doppler techniques may provide useful information on the prenatal diagnosis and understanding of the pathophysiology of FIUVV.



Yuichiro Nakai

Three-dimensional Fetal Echocardiographic Assessment of Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:3] [Pages No:346 - 348]

   DOI: 10.5005/jp-journals-10009-1671  |  Open Access |  How to cite  | 


We present our experience of diagnosing the fetal persistent left superior vena cava with the absent right superior vena cava using HDlive Flow with spatiotemporal image correlation (STIC). A 28-year-old pregnant Japanese woman, gravida 2, para 1, was referred to us for routine ultrasound screening at 28 weeks and 4 days of gestation. Two-dimensional sonography and radiant flow showed a dilated coronary sinus with the four-chamber view, and revealed a blood vessel on the left side of the pulmonary artery and absence of the superior vena cava with the three-vessel view. However, there was no other cardiac anomaly. Five cardiac views by an HDlive Flow with STIC clearly showed the absence of the right superior vena cava and a persistent left superior vena cava connected to a dilated coronary sinus. HDlive Flow with STIC provides additional diagnostic clues to evaluate abnormal systemic venous return in the fetus.



Bilateral Congenital Dacryocystoceles: HDlive Silhouette Image

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:2] [Pages No:349 - 350]

   DOI: 10.5005/jp-journals-10009-1665  |  Open Access |  How to cite  | 


HDlive Silhouette can demonstrate inner echo-free structures of the fetal body. In our case, this technique clearly showed fetal bilateral dacryocystoceles just below the medial canthal area under the orbits at 28 weeks and 3 days of gestation. We could clearly identify spatial relationships between the mouth, nose, orbits, and dacryocystoceles. These dacryocystoceles became obscure with advancing gestation. HDlive Silhouette may be a useful diagnostic technique for evaluating inner echo-free structures in fetal orbital regions.



Yuichiro Nakai

HDlive Flow for the Diagnosis of Double Outlet Right Ventricle at 19 Weeks of Gestation

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:4] [Pages No:351 - 354]

   DOI: 10.5005/jp-journals-10009-1673  |  Open Access |  How to cite  | 


We present a case of double outlet right ventricle (DORV) diagnosed prenatally using HDlive Flow with spatiotemporal image correlation (STIC) at 19 weeks of gestation. Bilateral choroid plexus cysts were noted on routine second-trimester screening. Ventricular septal defect, a small pulmonary artery, and parallel arrangement of great arteries were identified using conventional fetal echocardiography and Radiant Flow. HDlive Flow clearly showed a large aorta and small pulmonary artery leaving the right ventricle in parallel. Moreover, abnormal running of the aortic arch and descending aorta was depicted spatially. The diagnosis of DORV was confirmed antenatally. HDlive Flow may be an adjunctive technology to conventional fetal echocardiography for the assessment of normal and abnormal cardiac structures of the fetus in utero.



Sweta Singh

Chronic Ectopic Pregnancy: Clinical and Imaging Correlates

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:4] [Pages No:355 - 358]

   DOI: 10.5005/jp-journals-10009-1666  |  Open Access |  How to cite  | 


Aim: To describe the clinical correlates and ultrasound characteristics of chronic ectopic pregnancy. Background: Acute ectopic gestation is diagnosed by early pregnancy ultrasound and the clinical and imaging correlates are well known. However, in contrast, chronic ectopic pregnancy, accounting for approximately 6% of all ectopic gestations, is not a well-defined entity. This leads to diagnostic dilemmas and challenges in management. Case description: Fifteen women over a period of 6 years were included. The age ranged from 20 to 35 years, with the majority being multigravidas. Six women presented with abnormal uterine bleeding (AUB) and pain abdomen, four with AUB, and two with abdominal pain. The urine pregnancy test was positive in 11, and serum beta-human chorionic gonadotropin (S βhCG) was elevated in all. Ultrasound showed a heterogeneous mass in the pouch of Douglas (POD) and/or unilateral adnexa, with no internal vascularity. The right salpingectomy was done in 10, and the ipsilateral ovary was removed in 5. Three patients had unique presentations with urinary retention, jaundice, and fever. Conclusion: Chronic ectopic pregnancy should be the provisional diagnosis in a young multiparous woman with AUB and/or abdominal pain, if the ultrasound shows a heterogeneous mass in the POD and/or adnexa, with no internal vascularity, to plan optimal surgery. Clinical significance: The differential diagnosis of chronic ectopic pregnancy is a malignant germ cell tumor of the ovary. Hence, a definitive approach to the preoperative diagnosis of chronic ectopic pregnancy will lead to optimal patient outcomes.



Emilija Petanovska Kostova, Valentina Sotirovska, Daniela Stojanovska

Immature Ovarian Teratoma

[Year:2020] [Month:October-December] [Volume:14] [Number:4] [Pages:5] [Pages No:359 - 363]

   DOI: 10.5005/jp-journals-10009-1677  |  Open Access |  How to cite  | 


We present our experience of diagnosing immature ovarian teratoma with 2D and 3D vaginal ultrasound. A 29-year-old female patient with no symptoms was examined for routine gynecology examination before the start of an in vitro fertilization program. The patient had two previous surgeries both for ovarian cystectomy and histopathology finding of mature cystic ovarian teratoma. Left oophorectomy was performed for complex ovarian mass that demonstrated immature ovarian teratoma on final pathology. The neoplasm was well-differentiating (low-grade), according to two-tiered (low- and high-grade) system, and in IA stage, according to the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC). The oncologist's council proposed that no treatment is needed.


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