Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2022 | January-March | Volume 16 | Issue 1

PICTURE OF THE MONTH

Toshiyuki Hata, Riko Takayoshi, Takahito Miyake, Kenji Kanenishi

HDlive Silhouette Features of Multicystic Dysplastic Kidney

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:3] [Pages No:1 - 3]

Keywords: HDlive Flow, HDlive silhouette, Multicystic dysplastic kidney

   DOI: 10.5005/jp-journals-10009-1918  |  Open Access |  How to cite  | 

Abstract

We present our experience of HDlive silhouette features of a fetal multicystic dysplastic kidney (MCDK) at 31 weeks and 1 day of gestation. Two-dimensional sonography revealed a left MCDK larger than the right normal kidney. HDlive silhouette showed multiple cysts of various sizes in the left big kidney on the left side of the spine. HDlive Flow with HDlive silhouette clearly demonstrated spatial relationships between bilateral kidneys and intra-abdominal vasculatures. HDlive silhouette may provide information on assessing the spatial recognition of fetal MCDK.

Original Scientific Paper

Toshiyuki Hata, Aya Koyanagi, Tomomi Yamanishi, Saori Bouno, Tomomi Kawahara, Miyu Konishi, Riko Takayoshi, Takahito Miyake

Three-dimensional SlowflowHD for Assessment of Fetal Organ and Placental Microvasculature

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:7] [Pages No:4 - 10]

Keywords: Fetal organ microvasculature, Placental microvasculature, 2D SlowflowHD, 3D reconstruction, 3D SlowflowHD

   DOI: 10.5005/jp-journals-10009-1915  |  Open Access |  How to cite  | 

Abstract

Objective: To demonstrate spatial fetal organ and placental microvasculature using three-dimensional (3D) SlowflowHD. Methods: Seventy normal pregnancies at 11−39 weeks of gestation were studied to demonstrate spatial fetal organ (brain, lung, liver, spleen, adrenal gland, and kidney) and placental microvasculature using 3D SlowflowHD with a new transabdominal mechanical matrix probe. Results: In the first trimester of pregnancy, the whole-body vascularity of the fetus could be clearly depicted. Fetal intracranial vascularity including brain arteries and the venous system could be clearly identified. Characteristic spatial microvasculature of the fetal lung, liver, spleen, adrenal gland, and kidney could be clearly recognized. The microvasculature density of each organ increased with advancing gestation. Spatial relationships among fetal organs were also noted. The increased density of the placental microvasculature with advancing gestation was evident. Conclusion: 3D SlowflowHD can clearly demonstrate spatial fetal organ and placental microvasculature. This modality may provide novel information on normal and abnormal developments of fetal organs and the placenta in clinical practice and future research.

Original Scientific Paper

Edin Medjedović, Asim Kurjak, Sabaheta Jonuzovic-Prosic, Alma Suljevic

Recent Advances in the Assessment of Fetal Behavior in Preeclamptic Patients

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:8] [Pages No:11 - 18]

Keywords: Fetal behavior, Four-dimensional ultrasound, Kurjak antenatal neurodevelopmental test, Preeclampsia

   DOI: 10.5005/jp-journals-10009-1917  |  Open Access |  How to cite  | 

Abstract

Preeclampsia has a significant effect on maternal and fetal health, and in the most severe cases may lead to significant early or late-onset intrauterine growth restriction (IUGR), which can be diagnosed by ultrasound. In moderately severe and mild preeclampsia, the consequences for the fetus may be less severe. The main effect of preeclampsia on the fetus is malnutrition as the result of hypoxia due to uteroplacental vascular insufficiency, which occurs in approximately 30% of fetuses from preeclamptic pregnancies. This leads to various perinatal and neonatal complications including IUGR, emergency cesarean section (CS), premature birth, low birth weight, low APGAR scores, and often a longer stay in the neonatal intensive care unit and more severe acute respiratory distress syndrome after birth. The question is whether these consequences can be detected, and are there any indicators of early fetal distress before the development of growth restriction? Therefore, the aim is to investigate if observation of fetal behavior using four-dimensional ultrasound (4D US) in pregnancies with preeclampsia can reveal signs which could be added to existing diagnostic criteria for preeclampsia. The four-dimensional US offers the possibility of simultaneous visualization of real-time movements of the head, body, and all four extremities in three dimensions. Using the 4D US for assessment of fetal behavior and postnatal neuropediatric knowledge, a group from Zagreb proposed a prenatal screening test for assessment of the motor activity of the fetus, known as the Kurjak Antenatal Neurodevelopmental Test (KANET). The aim of the paper is to show that KANET is one of the most relevant tools for the assessment of fetal behavior, particularly in patients who are affected by preeclampsia. Based on our investigation we showed that preeclampsia clearly affects fetal behavior. The KANET test has proven to be a safe tool in assessing fetal neurodevelopment, especially in those at risk affected by severe preeclampsia. Prenatal fetal assessment is of great help to neonatologists in preparing for adequate and timely resuscitation procedures at birth. Low KANET scores always prompted close and intensive follow-up in pregnancies with severe preeclampsia to avoid adverse outcomes in both pregnant women and fetuses.

Observational Study

Amita Azad, Astha Lalwani, Rehana Najam

An Observational Study to Evaluate Single Deepest Vertical Pocket (SDP) and Color Doppler Indices (CDI) with Severity of Covid in Pregnant Women with COVID-19

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:6] [Pages No:19 - 24]

Keywords: COVID-19, Doppler findings, SDP

   DOI: 10.5005/jp-journals-10009-1911  |  Open Access |  How to cite  | 

Abstract

Aim: The present study was done for the assessment of the single deepest vertical pocket (SDP) and color Doppler indices (CDI) among COVID positive pregnant women to decide upon further management. Materials and method: A total of 102 patients were enrolled. The data collection was done by a single examiner following the protocol for the study. The study included confirmed COVID-19 positive pregnant patients. The inclusion standards were singleton pregnancy along with gestational age 28 weeks onward. Patients were divided on the basis of symptoms into asymptomatic and symptomatic subjects. Symptomatic subjects were further divided into mild, moderate, and severely symptomatic on the basis of established COVID guidelines. For the comparison of categorical variables, the analysis of Chi-square has been used. Results: The computation of Chi-square exhibited that the distribution of single deepest vertical pocket (SDP) score did not differ between asymptomatic and symptomatic subjects. Abnormal Doppler findings in the umbilical artery were found to be significantly more among subjects with severe COVID-19 symptoms compared to women with mild to moderate symptoms. Among women with abnormal Doppler, there were 6.3% vaginal and 93.7% cesarean deliveries. Mean APGAR at 1 minute and 5 minutes after birth was found to be 5.05 ± 1.09 and 3.16 ± 0.92 in asymptomatic and 5.24 ± 1.24 and 3.40 ± 1.02 in symptomatic patients, respectively. In symptomatic subjects, NICU admission was significantly more (54.0%) compared to asymptomatic subjects (16.0%). Conclusion: As the research has indicated that COVID-19-infected pregnant women may experience rapid and increasing placental insufficiency, it appears that a comprehensive assessment and management of the mother is required.

REVIEW ARTICLE

Amela Muftić, Edin Medjedović, Jasminka Kurtalic, Nedim Begic, Sabaheta Jonuzovic-Prosic, Edin Begic

Ultrasound-guided Neuraxial Analgesia in Obstetrics

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:6] [Pages No:25 - 30]

Keywords: Analgesia, Childbirth, Pain

   DOI: 10.5005/jp-journals-10009-1912  |  Open Access |  How to cite  | 

Abstract

Analgesia in obstetrics has an essential place during childbirth. Pain during childbirth has two components, sensory and emotional. Adequate analgesia affects the course of labor, reducing the cardiovascular, respiratory, and gastrointestinal effects of catecholamines. The use of ultrasound in anesthesia has its advantages as it enables accurate determination of the lumbar interspaces in neuraxial analgesia techniques. This review aims to show the advantage of using ultrasound-guided neuraxial analgesia in obstetrics compared to the conventional blind approach.

REVIEW ARTICLE

Ritsuko K Pooh, Megumi Machida, Nana Matsuzawa

Fetal Brain Structure and CNS Anomalies

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:22] [Pages No:31 - 52]

Keywords: Fetal brain, Molecular genetics, Three-dimensional neurosonography, Transvaginal ultrasound

   DOI: 10.5005/jp-journals-10009-1921  |  Open Access |  How to cite  | 

Abstract

As the brain is an organ that must be understood as a three-dimensional (3D) structure, and because the fetal skull ossifies in late pregnancy, it is difficult to depict detailed structures in the brain using conventional horizontal cross-sectional images captured by transabdominal ultrasound. However, there are large spaces such as anterior/posterior fontanels and sagittal sutures in the fetal skull. By using these spaces as a window for ultrasound, it becomes easier to observe the brain structure. Transvaginal fetal 3D neurosonography and transvaginal ultrasound have made it possible to observe congenital brain structural abnormalities and cortical dysgenesis in more detail. Transvaginal 3D ultrasound imaging has been reported to be effective in the evaluation of fetal brain structure. Images of normal brain development, intracerebral vascular architecture, brain malformations, brain disorders such as intracerebral hemorrhage and stroke, and abnormalities in cortical development have gradually revealed the previously unknown development and pathology of the fetal brain. Fetal 3D neurosonography provides information on the orientation of the fetal brain, brain development during pregnancy, the exact location of brain lesions, and the inner structure of the lesions. Detailed neuroimaging is now available for diagnosis of the central nervous system, and genetic tests such as chromosomal microarrays, exome sequencing, and genome sequencing add information on genetic causative factors. The combination of detailed neurosonography and molecular genetics has established a new interdisciplinary field of fetal neurology called “neurosonogenetics,” which will enable accurate perinatal management and care in the future.

REVIEW ARTICLE

Ashok Khurana

Recent Advances in 3D Assessment of Mullerian Anomalies

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:13] [Pages No:53 - 65]

Keywords: Accessory horn, Bicornuate, Bicorporeal, Didelphys, Hemiuterus, Mullerian anomalies, Septate, Unicornuate, Uterine septum

   DOI: 10.5005/jp-journals-10009-1916  |  Open Access |  How to cite  | 

Abstract

Mullerian anomalies present with a variety of clinical manifestations including infertility (Dysmorphic/T-shaped uterus), repeated first-trimester spontaneous miscarriages (Septate uterus), fetal growth restriction, fetal malposition, preterm labor, preterm delivery, obstructed or nonprogressive labor, and retained placenta. Paradoxically, a significant number of these anomalies are incidental findings and this creates a dilemma with offering treatment options. An unambiguous label of the type of dysmorphology is central to the solution to this problem. Consequently, attempts are being made to define these better in order to optimize the treatment offered. Ultrasound is one imaging tool that is widely available, economical, lacks radiation and can be achieved rapidly, and is now the first step to diagnosis. Two-dimensional (2D) ultrasound, however, misses a large number of anomalies because it is often impossible to demonstrate a coronal plane. This plane is necessary to delineate the external uterine contour, which is central to labeling a mullerian anomaly. Three-dimensional (3D) US is recommended for the diagnosis of mullerian anomalies in symptomatic patients belonging to high-risk groups and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopy should be carried out for patients with suspected complex malformations or in diagnostic dilemmas. Adolescents with symptoms should be thoroughly assessed with 2D and 3D ultrasound, MRI, and with endoscopy.

REVIEW ARTICLE

Panos Antsaklis, Sanja Malinac Malojčić, Maria Papamichail, Marianna Theodora, George Daskalakis

Evolution of Assessment of Fetal Brain Function

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:13] [Pages No:66 - 78]

Keywords: Brain development, Evolution, Fetal brain function, Ultrasound

   DOI: 10.5005/jp-journals-10009-1919  |  Open Access |  How to cite  | 

Abstract

Assessment of the structure and function of the fetal nervous system has been one of the greatest physicians’ challenges for decades. Advances in ultrasound techniques and especially the evolution of three-dimensional and four-dimensional (4D) ultrasound have made reality the evaluation of fetal anatomy and activity in real-time and in extreme detail. The process of human brain development and maturation is reflected by a specific behavioral pattern that undergoes changes and progresses reciprocal to each week of growth, mirroring the neurological integrity of the fetal brain. Therefore, evaluation of patterns of fetal behavior during the different stages of growth could make possible the distinction between normal and abnormal fetal neurodevelopment and more importantly facilitate early diagnosis of a wide variety of functional abnormalities of the fetal nervous system. To this direction, a pioneer test introduced by Kurjak; KANET (Kurjak Antenatal Neurodevelopmental Test) uses 4D ultrasound to assess fetal behavior and movements in a simulative way of postnatal neonatal neurological evaluation. Evidence from multicenter studies shows that the test indicates the potential to identify fetuses at risk for neurodevelopment impairment and it is applicable in everyday clinical practice.

REVIEW ARTICLE

Elitza Markova-Car, Krešimir Pavelić

Preimplantation Genetic Diagnosis

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:4] [Pages No:79 - 82]

Keywords: Embryo, Microarray, Next generation sequencing, Preimplantation genetic diagnosis

   DOI: 10.5005/jp-journals-10009-1920  |  Open Access |  How to cite  | 

Abstract

Preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) is an early form of prenatal diagnosis which allows that, before the pregnancy has begun, embryos can be tested for genetic disorders.1 The rationale behind the method lies in the removal of cells from early embryos and genetic analysis of these cells before being transferred to the uterus. This procedure offers an advantage for those couples having genetic disorders whose offspring has an increased risk of a specific genetic condition by helping in the delivery of a healthy baby or prevention of repeated spontaneous abortions.2 As a result, PGS has developed as a valuable tool for enhancing pregnancy success with assisted reproductive technologies.3 In fact, PGD may possibly be suggested for any disorder for which molecular testing can be performed.

REVIEW ARTICLE

Giovanni Monni, Ambra Iuculano, Cristina Peddes

Guidelines for Invasive Prenatal Procedures

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:8] [Pages No:83 - 90]

Keywords: Diagnosis, Guidelines, Invasive prenatal procedures, Pathologies of chromosomal and/or genetic origin

   DOI: 10.5005/jp-journals-10009-1913  |  Open Access |  How to cite  | 

Abstract

Invasive prenatal diagnosis is a series of procedures necessary to obtain fetal or embryo-fetal tissues useful for diagnosing pathologies of chromosomal and/or genetic origin. It can also be used for detecting infectious agents, metabolism errors, and/or for studying the composition of fetal fluids such as blood and urine. Most common prenatal techniques are chorionic villus sampling, amniocentesis, and cordocentesis. They are options to choose from according to the gestational age and the type of fetal pathology to investigate.

CASE REPORT

Edin Medjedović, Milan Stanojevic, Nedim Begic, Zijo Begic, Amer Iglica, Edin Begic, Sanjin Dekovic, Alma Suljevic, Sabaheta Jonuzovic-Prosic

A Single Ventricle Defect: A Case Report from Fetal Echocardiography to Cardiac Surgery

[Year:2022] [Month:January-March] [Volume:16] [Number:1] [Pages:4] [Pages No:91 - 94]

Keywords: Congenital heart defects, Fetal echocardiography, Postnatal cardiac assessment, Treatment

   DOI: 10.5005/jp-journals-10009-1914  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of the paper is to show a report of rare, life-threatening congenital heart defect (CHD), emphasizing the importance of fetal echocardiography for the diagnosis and treatment of CHD improving the outcome. Case description: The diagnosis of the single ventricle, rudimentary left ventricle, common atrium, double outlet right ventricle (DORV), transposition of the great arteries (TGA), and mild pulmonary stenosis was made prenatally at routine fetal echocardiography scan and confirmed postnatally by pediatric cardiologist assessment, who indicated postnatal cardiosurgical treatment. According to planned treatment, the first step was establishment of the central shunt (polytetrafluoroethylene 3.5 mm) between the ascending aorta and the left pulmonary artery (LPA), followed by a bidirectional Glenn shunt. The patient was hemodynamically stable at discharge, treated with acetylsalicylic acid as antiaggregating agent. In the future, Fontan procedure as the third surgical procedure is planned. Conclusion: Accurate prenatal diagnosis of CHD confirmed postnatally enabled to prepare medical team and parents for the treatment enabling survival of the infant and better parental coping with the diagnosis and treatment of severe life-threatening CHD.

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