Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2021 | October-December | Volume 15 | Issue 4

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Asim Kurjak

Distance Learning and Artificial Intelligence: New Challenges for Donald School Educational Activities

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:3] [Pages No:323 - 325]

   DOI: 10.5005/jp-journals-10009-1831  |  Open Access |  How to cite  | 



Toshiyuki Hata

HDlive Flow with HDlive Silhouette for Diagnosis of Velamentous Cord Insertion

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:4] [Pages No:326 - 329]

Keywords: Accenturiate placenta, Fork-like attachment of umbilical cord, HDlive flow, HDlive silhouette, Mangrove-like attachment of umbilical cord, Velamentous cord insertion

   DOI: 10.5005/jp-journals-10009-1809  |  Open Access |  How to cite  | 


Velamentous cord insertion is often associated with various complications during pregnancy and labor. Color Doppler ultrasound is a useful diagnostic tool for the prenatal diagnosis of velamentous cord insertion. HDlive flow with HDlive silhouette is the latest imaging modality consisting of power Doppler and grayscale technologies, and it provides additional information on normal and abnormal placental and umbilical cord blood flow. In the first case of velamentous cord insertion, HDlive flow with HDlive silhouette clearly showed a fork-like attachment of the umbilical cord on the fetal membrane near the placenta. In the second case of accenturiate placenta with velamentous cord insertion, HDlive flow with HDlive silhouette clearly revealed the number and direction of aberrant vessels on the fetal membrane connected to both placentas (mangrove-like attachment of umbilical cord). HDlive flow with HDlive silhouette may be a useful diagnostic modality for the precise prenatal diagnosis of velamentous cord insertion.



Sanja Plavsic Kupesic

Faculty Development in OB-GYN Ultrasound and Technology Tools to Achieve Academic Success

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:1] [Pages No:330 - 330]

   DOI: 10.5005/jp-journals-10009-1802  |  Open Access |  How to cite  | 



Sanja Plavsic Kupesic, Jose M de la Rosa, Zuber D Mulla

Academic Collaboration between the Paul L. Foster School of Medicine and Ian Donald Inter-University School of Ultrasound in Obstetrics and Gynecology: A Global Health Program's Success Story

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:5] [Pages No:331 - 335]

Keywords: Global health program, Interinstitutional collaboration, OB-GYN ultrasound, Research, Scholarship

   DOI: 10.5005/jp-journals-10009-1803  |  Open Access |  How to cite  | 


Aim: To review the outcomes of the global health program and interinstitutional academic collaboration between the Paul L. Foster School of Medicine (PLFSOM) at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso) and the Ian Donald Inter-University School of Ultrasound in Obstetrics and Gynecology. Background: The Ian Donald Inter-University School of Ultrasound was established in 1982 by a multidisciplinary group of enthusiasts. Today our School has active international branches in 75 countries worldwide. They aim to address the specific educational and training needs of clinicians performing OB-GYN ultrasound and organize courses, workshops, congresses, and national conferences according to the character of the respective country, region, and/or area. TTUHSC El Paso is located in the second largest binational metropolitan area on the US–Mexico border. It provides the opportunities and environment for direct intellectual and interpersonal exchanges among health sciences university students on one campus. Results: During the last 15 years, more than 50 individual TTUHSC El Paso faculty members, six residents, 10 medical students, and 11 staff members participated in writing 173 chapters and 88 Ian Donald School educational videos created. During the same time, more than 40 individual faculty members, 19 students, seven residents, and five staff members contributed to 53 articles of the Donald School Journal of Ultrasound in Obstetrics and Gynecology. Conclusion: Access to valuable international resources and expertise in the field of OB-GYN ultrasound opened new perspectives on research and scholarship which fostered collaboration, relationship building, and career development of the global health program participants.



Sanja Plavsic Kupesic

Turning Your Clinical, Administrative Work, and Education into Scholarship

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:4] [Pages No:336 - 339]

Keywords: Administrative activities, Clinical work, Educational activities, Faculty Development, Scholarship, Scholarly projects

   DOI: 10.5005/jp-journals-10009-1804  |  Open Access |  How to cite  | 


Aim: To define scholarship in academic medicine and describe how clinical faculty can develop scholarship from their daily clinical, educational, and administrative activities. Background: Understanding different types of scholarship is crucial for career planning and development of the junior and mid-career clinical educators. Results: This article provides examples and steps for turning clinical educators’ work into research and scholarly projects. Different types of scholarship and faculty development trends are explained and documented. Conclusion: Faculty development programs focusing on teaching and learning, education-centered research projects, and interdisciplinary collaboration enrich academic experiences and success of junior and mid-career clinical educators.



Zuber D Mulla

Best Practices in the Analysis of Ultrasonographic Research Data: Ancora Imparo

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:7] [Pages No:340 - 346]

Keywords: Collider-stratification bias, Confounding, Directed acyclic graphs, Generalized linear models, Longitudinal data analysis, Overadjustment bias, Quantile regression, Ultrasound, Women's health

   DOI: 10.5005/jp-journals-10009-1800  |  Open Access |  How to cite  | 


Aim: To briefly review several regression models and epidemiological research strategies that are of interest to women healthcare professionals who are engaged in scholarship involving data from ultrasound imaging studies. Background: Advances in statistical methods in epidemiology in the past two decades can aid clinician investigators. However, these recent developments in research methods may not be well-known outside the disciplines of biostatistics and epidemiology. Review results: Several types of regression models are discussed including log-binomial regression and quantile regression. Modern methods for the analysis of repeated measures data including generalized estimating equations are reviewed. Finally, the utility of directed acyclic graphs (DAGs), a type of causal diagram, is introduced. Directed acyclic graphs are useful in identifying confounders and avoiding a variety of biases such as overadjustment bias and collider-stratification bias. Conclusion: Data arising from ultrasound imaging studies provide a wealth of scholarly opportunities for clinicians. The application of sound, modern statistical techniques will ensure the design and conduct of high-quality research investigations. Clinical significance: Physicians using ultrasound may encounter variables with a skewed distribution such as nuchal translucency or a dataset in which the dependent variable, such as an umbilical artery Doppler index, is measured multiple times. Special methods are required to analyze such datasets properly. Clinician researchers, especially early-career faculty, should consider collaborating with biostatisticians and epidemiologists.



Diego F Niño, Thwe Htay, Patricia Rojas-Mendez, Naima Khamsi, Damaris Rosado, Irene Alexandraki

Integration of Ultrasonography in Obstetrics and Gynecology in Pre-clerkship Medical Education

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:5] [Pages No:347 - 351]

Keywords: Clerkship, Medical education, Obstetrics and gynecology, Pre-clerkship, Ultrasound

   DOI: 10.5005/jp-journals-10009-1805  |  Open Access |  How to cite  | 


The use of ultrasonography has been extensively shown to contribute to improved patient care, safety, and satisfaction. Thus, ultrasound (US) instruction and skill development have become a focus of interest in undergraduate medical education (UME) to enhance student preparedness for future training and professional practice. We provide a review of the literature regarding current practices and recommendations for the implementation of US training curricula within pre-clerkship medical education. Finally, we provide an overview of how we have integrated US training in obstetrics and gynecology into the pre-clerkship curriculum at our institution



Carla A Martinez, Anjana R Nair, Sanja Plavsic Kupesic

Ultrasound Training for Obstetrics and Gynecology Residents

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:7] [Pages No:352 - 358]

Keywords: OB-GYN residency, OB-GYN ultrasound curriculum, OB-GYN ultrasound training, Obstetric ultrasound, Pelvic ultrasound

   DOI: 10.5005/jp-journals-10009-1801  |  Open Access |  How to cite  | 


The purpose of ultrasound training for obstetrics and gynecology (OB-GYN) residents is to advance the safe and effective use of transabdominal and transvaginal sonography in reproductive medicine, infertility, gynecologic oncology, urogynecology, normal, and abnormal pregnancy. The purpose of obstetrical ultrasound training is to provide an integrated approach of hands-on ultrasound training, required readings, and web-based lecture series around obstetrics. The creation of the pelvic ultrasound curriculum was a part of a research project, which resulted in multiple national and international presentations and publications. Every year of their postgraduate training, the residents spend 1 month in the ultrasound clinic, working through various cases to build technical skills in performing OB-GYN ultrasounds. The training begins with a review of the institution-specific online modules, followed by weekly rotation/hands-on training sessions and periodic ultrasound simulations. Throughout the 4 years of training the resident spends designated time in the ultrasound clinic as well as gain hands-on training on inpatient antepartum patients. Comprehensive training allows residents to perform a well-structured ultrasound examination, write a structured report and graduate with competency in OB-GYN ultrasound. It is designed to help them develop the fundamental knowledge, theoretical background, and mastery of skills of effective diagnostic ultrasound that can be incorporated in their clinical practice postresidency.



Jesica Urbina, Stormy M Monks, Scott B Crawford

Simulation in Ultrasound Training for Obstetrics and Gynecology: A Literature Review

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:6] [Pages No:359 - 364]

Keywords: Gynecology, Obstetrics, Simulation, Ultrasound

   DOI: 10.5005/jp-journals-10009-1816  |  Open Access |  How to cite  | 


Aim: The purpose of this review is to present the state of the art for simulation-based ultrasound training in obstetrics and gynecology. Background: Ultrasound (US) is a primary tool used in obstetrics and gynecology and has become indispensable in prenatal assessment and for diagnosing various gynecological pathologies. The core skills for US, however, are highly operator dependent. The American Institute of Ultrasound in Medicine (AIUM) assembled a multisociety task force in 2017 to develop standardized recommendations for curricula and competency assessment tools for the performance of basic OB/GYN ultrasound examinations in residency programs. Due to diminishing opportunities for training during residency programs, the task force encourages the use of US simulation during residency training and expects simulation to be a significant part of the curriculum and competency assessment process. Methods: A literature search was conducted for the key terms “ultrasound,” “OB/GYN,” “simulation,” and “phantoms,” for works published in English from 2017–2021 with clinically relevant results reviewed. Results: Based on the reviewed literature, there are three primary approaches for US simulation. These are grouped by their method of image generation: (1) software-based learning that occurs digitally or online through web-based programs or virtual reality (VR) systems, (2) mannequin-based, where a high-fidelity mannequin is paired with actual US images from a dataset, or 3) phantom-based training devices that simulate anatomical features for the practice of diagnostic or procedural skills. Commercially available mannequin-based simulators offer numerous pathologies for the evaluation of first and second-trimester pregnancies as well as normal anatomic features, allowing the learner to perform standard obstetric measurements and calculations in different fetal positions. Alternatively, the creation of custom US simulation trainers by a simulation center is a well-established technique to meet the needs of a specific training program. This may be to provide less expensive alternatives to commercial products, meet unique simulation requirements, or produce consumable simulation components. Conclusion: Simulation is an important component of resident training in OB/GYN due to the diminishing opportunities during clinical rotations. There are commercially available options for training in US imaging, acquisition, interpretation, and integration into diagnostics, however, the limitations for these are that they may not be customizable and can be rigid in their learning modules and objectives. Thus, self-made models can be constructed using materials that have been characterized for their US properties. Multiple phantom materials can be aggregated to construct functional task trainers that can be used for training in the acquisition of targets along various planes. Additionally, simulators allow for training of US-guided invasive procedures, which many times are low incidence/high-risk tasks. Clinical significance: With increasing time pressures for procedural and clinical efficiency as well as requirements for improved patient safety, clinical training opportunities are no longer a stand-alone option for resident procedural experience and training requirements. The use of simulation training in external training labs, or as a component of just-in-time training, is being used to meet these needs. Learners can gain required procedural baseline skills to allow focus on patient care delivery in the healthcare environment and less on device interaction, muscle memory training, or image interpretation.



Courtney M Queen, Michele C Williams

Practical Strategies for Designing and Facilitating Teleconferences in Medical Education

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:6] [Pages No:365 - 370]

Keywords: Distance education, Engagement strategies, Interactivity tools, Medical education, Remote active learning, Teleconferencing, Videoconferencing, Virtual session design

   DOI: 10.5005/jp-journals-10009-1806  |  Open Access |  How to cite  | 


Teleconferences played and continue to play an important role in medical education and the clinical encounters for ensuring distancing during the pandemic. The teleconferencing tools provide interactivity features that when leveraged properly can facilitate active learning and increase participant engagement. This article provides the teleconference tools that can facilitate active learning and increase participants’ engagement.



Anthony P Catinella, Mary J Amaro Esparza

Leading Virtual Teams: A Review of Best Practices

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:6] [Pages No:371 - 376]

Keywords: Communication, Human behavior, Human factors, Leadership, Teams, Team effectiveness, Virtual meetings, Virtual teams, Virtual work

   DOI: 10.5005/jp-journals-10009-1826  |  Open Access |  How to cite  | 


With the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare and businesses abruptly had to adopt the use of virtual meeting space as a means to support their work. Users experienced change with both positive and negative results, with reports of “Zoom“ fatigue as an example of a new effect brought on by this newer medium. However, little guidance has been offered to clinicians in principles and practices to support the use of virtual teams and meetings. This narrative review summarizes best practices in developing virtual teams and running virtual meetings. The advantages and disadvantages of the virtual environment are summarized, including multitasking as both positive and negative aspect of the expanded virtual environment. To support both the task and relationship functions of teams through virtual meeting space, recommendations are provided to ensure such teams and meetings are optimized.



Diego De la Mora

Telehealth, Ultrasound, and the Physician of the Future

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:3] [Pages No:377 - 379]

Keywords: Graduate medical education, Obstetrics and gynecology, POCUS, Telehealth, Telemedicine, Ultrasound, Undergraduate medical education, Women's health

   DOI: 10.5005/jp-journals-10009-1827  |  Open Access |  How to cite  | 


Aim and objective: In this article, we explore the current practices, challenges, and opportunities to the integration of telehealth in the field of ultrasonography for the education of the physician in the care of obstetrics and gynecology patients. Telemedicine and telehealth (TM/TH) have been used in obstetrics and gynecology primarily as an adjunct service to the usual care for encounters that require a minimal physical examination. Background: Telemedicine and telehealth are commonly interchangeable terms referring to the provision of clinical services at a distance. Before the coronavirus disease-2019 (COVID-19) pandemic, the United States (US) was seeing modest but significant growth in the use of TM/TH. The COVID-19 pandemic appears to have accelerated the implementation of TM/TH. Review results: Teleradiology, in particular, the use of asynchronous (i.e., store-and-forward) technology, is also used for maternal–fetal medicine consultations. Other TM/TH modalities such as fetal echocardiography, remote fetal monitoring, and remote patient monitoring (RPM) are slowly becoming more popular. Despite the ample benefits of TM/TH, undergraduate and graduate medical training on TM/TH and point-of-care ultrasound (POCUS) skills have been historically deficient. Multiple challenges remain for the expansion of TM/TH services including regulatory, reimbursement, and licensing policy. For the incorporation of ultrasound in TM/TH visits, a greater infrastructure is needed. Considerations for this infrastructure include rural broadband internet access and modernization of the information technology infrastructure capable of exchanging ultrasound images electronically in a secure and HIPPA-compliant interface. Conclusion: There is ample reason to remain optimistic about the future of TM/TH in the field of ultrasonography and clinical care for obstetrics and gynecology patients. To take advantage of these opportunities, it is imperative that the current challenges to the expansion of TM/TH, including the gaps in the medical education system, be addressed systematically. Clinical and Educational significance: Advances in POCUS, intelligent navigation, and teleoperated ultrasound technology provide a prospect of opportunities to advance TM/TH care while expanding educational opportunities. The most recent expansion of TM/TH after the COVID-19 pandemic is likely to launch TM/TH into a new level of market penetration, making the need for undergraduate and graduate medical education on TM/TH skills ever more relevant.



Timothy J Rafael

An Ounce of Prevention: A Review of the Most Common Errors in OB/GYN Ultrasound Leading to Litigation and How to Avoid Them

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:7] [Pages No:380 - 386]

Keywords: Anomaly, Congenital heart malformations, Down syndrome, Prevention, Re-scanning, Sonography, Ultrasound

   DOI: 10.5005/jp-journals-10009-1817  |  Open Access |  How to cite  | 


The use of ultrasound in the field of Obstetrics and Gynecology (OB/GYN) has become ubiquitous. As OB/GYN is a higher-risk specialty pertaining to the risk of litigation, it is no surprise that lawsuits involving ultrasound in OB/GYN are not uncommon. Errors in ultrasound are not rare, with certain types of errors seemingly more prone to litigation. Upon examination of the past 40 years of literature, it appears that the most frequent types of errors fall into one of three categories: (1) technical/procedural, (2) perception/interpretation, and (3) communication/documentation. The aim of this review is to break down the types of ultrasound errors that fall into these categories and utilize “take-home” summary points as a way of strategizing the prevention of these types of errors. Among other methods, these summary points emphasize adequate ultrasound training and continuing education, knowledge of the guidelines, ample patient counseling, effective communication with referring providers, and meticulous documentation. Upon completion of this review, it is hoped that the reader has an appreciation of the steps a practitioner can take to avoid these types of lawsuits in the future.



Christiane Herber-Valdez, Sanja Kupesic-Plavsic

Satisfaction and Shortfall of OB-GYN Physicians and Radiologists

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:6] [Pages No:387 - 392]

Keywords: Anxiety, Mental distress, Obstetrics-Gynaecology, Physicians, Radiologists, Shortfall, Ultrasound

   DOI: 10.5005/jp-journals-10009-1822  |  Open Access |  How to cite  | 


Ultrasound is pivotal to the practice of obstetrics-gynecology (OB-GYN). In the US, physicians who perform ultrasound are facing the unprecedented need for their services and skills. OB-GYNs, in particular, have been challenged to meet rising demands in women's healthcare, as a result of an increasing female population, while the supply of physicians is not keeping pace. The ACOG projects current shortages will continue to grow to a deficit of up to 22,000 OB-GYNs by 2050. The future of the OB-GYN workforce is compromised by an aging OB-GYN population, insufficient OB-GYN residency positions, and a decreasing number of young physicians choosing to specialize in OB-GYN. As a consequence of mismatched supply and demand, practicing OB-GYNs are experiencing alarming rates of medical burnout, jeopardizing their mental health and wellness. The COVID-19 pandemic has further exacerbated risks to mental health; however, OB-GYNs have reported higher levels of burnout compared to other specialties, both before and after the pandemic. This article examines the threats to OB-GYN's central role in the provision of OB-GYN ultrasound, including factors contributing to insufficient growth of the OB-GYN workforce, and the resulting impacts on practicing OB-GYNs’ job satisfaction and overall well-being. Data on medical burnout affecting OB-GYNs, both before and after the COVID-19 pandemic, is presented along with a comparison of job satisfaction and wellness data collected from OB-GYNs and radiologists–the two groups of specialists performing female pelvic and OB ultrasound exams in the US. Understanding the factors that discourage medical graduates from entering into OB-GYN residencies is critical, not only for recruitment but for the development of strategies to support currently practicing OB-GYNs. Prevention of medical burn-out among OB-GYNs will be essential to keep OB-GYNs practicing through retirement age while attracting others to the specialty. The creation of rewarding work environments, which allow for a healthy work-life balance, will be essential to meeting the demand for specialized women's health and reproductive care. Protecting the well-being of those practicing now, will be instrumental to the development of a sufficient OB-GYN workforce, and ensure its central role in the provision of OB-GYN ultrasound.


Original Scientific Paper

Jalpa Shah, Chaitanya Nagori, Sonal Panchal, Manish Thaker

Impact of Intraendometrial Vascularity on Implantation Rates in Frozen Blastocyst Transfer

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:8] [Pages No:393 - 400]

Keywords: Blastocyst, Conception rates, Endometrial vascularity, Frozen embryo transfer, Miscarriage rates

   DOI: 10.5005/jp-journals-10009-1823  |  Open Access |  How to cite  | 


Introduction: Implantation remains the main limiting factor in the success of in vitro fertilization treatment, despite major advances made in this field. This study was done to evaluate whether intraendometrial vascularity affects the outcome in cases of Frozen embryo transfer (FET). Materials and methods: In total, 226 patients undergoing frozen embryo transfer out of the total 233 patients were recruited for the study. Endometrial preparation was done by artificial cycle protocol in all the patients with estradiol valerate. Endometrium is evaluated for its thickness and its morphology as seen on B-mode ultrasound. Endometrial vascularity is evaluated by power Doppler (PD) and pulse-wave Doppler. Post-embryo transfer of two Grade 1 frozen-thawed blastocyst, judicial luteal support was given. Beta human chorionic gonadotropin (β-hCG) was checked after 14 days for confirmation of pregnancy in all the patients. In all β-hCG positive cases, ultrasound was done after 10 days. All the patients with pregnancy were followed up by ultrasound for the entire first trimester and miscarriages were documented. Results: Patients showed higher positive pregnancy rate and lesser miscarriage rate with vascular penetration in zone 3 and zone 4 of the endometrium. Conception rate and miscarriage rate did not vary significantly with change in endometrial thickness beyond 7 mm in Frozen embryo transfer cycles.


Original Scientific Paper

Janet A Akinmoladun

Prenatal Sonographic Diagnosis of Musculoskeletal Anomalies in South Western Nigeria: A Hospital-based Study

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:6] [Pages No:401 - 406]

Keywords: Congenital anomalies, Fetus, Musculoskeletal, Prenatal diagnosis, Ultrasound

   DOI: 10.5005/jp-journals-10009-1824  |  Open Access |  How to cite  | 


Introduction: Musculoskeletal anomalies are the second most common anomalies after anomalies of the central nervous system. The presence of these anomalies in children can cause emotional upset and social stigma to the affected parents. Early detection of these anomalies is important in the management of the condition and may help to reduce perinatal morbidity and mortality associated with them. The objective of this study is to describe the musculoskeletal anomalies diagnosed during prenatal ultrasound screening for anomalies in our center, the associated anomalies and outcomes. Materials and methods: This is a retrospective evaluation of all cases of musculoskeletal anomalies detected during prenatal ultrasound screening for fetal anomalies at the University College Hospital, Ibadan, Nigeria between 2012 and 2018. Results: Two thousand six hundred and thirty-four (2,634) fetuses were screened prenatally with ultrasound for anomalies over a 6-year period. A total of 14 (0.4%) of the fetuses had musculoskeletal anomalies. Four (28.6%) of the anomalies were isolated while the remaining had associated anomalies involving other systems. Seven (50.0%) of the pregnancies with these anomalies were terminated before term because of the severity and/or associated anomalies. Six (42.9%) of the fetuses were delivered at term of which three had early neonatal death. Conclusion: Prenatal screening for anomalies affecting the musculoskeletal system is essential in the primary prevention of disability and reducing perinatal mortality and morbidity.



Priya Kapahi, Abhiraj Kakkar

Fetal Cholelithiasis: A Case Series of Antenatal Sonographic Diagnosis with Review of Literature

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:4] [Pages No:407 - 410]

Keywords: Echogenic foci, Fetal cholelithiasis, Fetal gall bladder

   DOI: 10.5005/jp-journals-10009-1815  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the antenatal diagnosis of fetal cholelithiasis with postnatal outcome. Background: Fetal cholelithiasis and/or echogenic sludge in the gallbladder is an infrequent ultrasonographic finding seen as echogenic material with or without posterior acoustic shadowing. Fetal cholelithiasis is most commonly seen during the third trimester of pregnancy. In the majority of cases, fetal cholelithiasis/sludge shows spontaneous resolution within a few months of postnatal life. But, it is very important to assure that echogenic foci are present inside the gallbladder lumen to rule out other causes of right upper quadrant echogenicities. Use of 3-dimensional (3D) scan can aid in the diagnosis of fetal cholelithiasis. Case description: Through this case series, four cases of fetal cholelithiasis were followed up in their postnatal period to evaluate the outcome. Clinical significance: A case of fetal cholelithiasis should be followed for an adequate time frame before thinking on the grounds of surgical management. Conclusion: Unlike adult cholelithiasis, fetal cholelithiasis shows a benign course with self-resolution.



Hari K Shrestha, Geeta Gurung, Suphatra Koirala, Ingima Shrestha, Siddhartha K Shrestha

Intraligamentary Pregnancy: A Case Report

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:3] [Pages No:411 - 413]

Keywords: Abdominal pregnancy, Magnetic resonance imaging, Placenta, Ultrasonography

   DOI: 10.5005/jp-journals-10009-1830  |  Open Access |  How to cite  | 


Intraligamentary pregnancy is a type of ectopic pregnancy in which gestation grows between the folds of broad ligament of uterus. It is situated intra abdominally and retroperitoneal. It is an extremely rare form of ectopic pregnancy. This type of pregnancy has been reported to occur in one out of 250 ectopic gestations. Here, we report a case of a primigravidae lady at 15 weeks of gestation, after ultrasound revealed with extrauterine pregnancy with a live fetus lying outside the uterus, which was then confirmed by MRI and revealed intraligamentary pregnancy in explorative laparotomy.



Yuichiro Nakai

Mitral and Aortic Atresia, Ductus Arteriosus Aneurysm, and Aortic Tortuosity: First- and Second-trimester HDlive Flow Features

[Year:2021] [Month:October-December] [Volume:15] [Number:4] [Pages:3] [Pages No:414 - 416]

Keywords: Aortic tortuosity, Ductus arteriosus aneurysm, HDlive Flow, Mitral and aortic atresia, Prenatal diagnosis, STIC

   DOI: 10.5005/jp-journals-10009-1825  |  Open Access |  How to cite  | 


We present the first- and second-trimester HDlive Flow features of mitral and aortic atresia, ductus arteriosus aneurysm, and aortic tortuosity and kinking. Retrograde aortic flow was evident, and aortic tortuosity and kinking were suspected using HDlive Flow with spatiotemporal image correlation (STIC) at 13 weeks and 6 days of gestation. Mitral and aortic atresia and tricuspid regurgitation were recognized by conventional fetal echocardiography at 20 weeks of gestation. HDlive Flow clearly showed retrograde aortic flow, ductus arteriosus aneurysm, and helical aortic tortuosity and aortic kinking. Congestive heart failure (pericardial effusion, pleural effusion, and ascites) was also evident. Termination of pregnancy was conducted due to the parent's desire to discontinue the pregnancy. There were no apparent phenotypic features of connective-tissue disorder. The parents refused further work-up such as autopsy, chromosomal analysis, and genetic studies of the baby. To the best of our knowledge, this is the first report on aortic tortuosity and kinking of a fetus in the first trimester of pregnancy using HDlive Flow with STIC.


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