Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2022 | April-June | Volume 16 | Issue 2

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Images in Obstetrics

Toshiyuki Hata

Recent Advances in 3D/4D Ultrasound in Obstetrics

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:12] [Pages No:95 - 106]

Keywords: 3D/4D ultrasound, HDlive, HDlive Flow, HDlive silhouette, Obstetrics, SlowflowHD, Superb microvascular imaging

   DOI: 10.5005/jp-journals-10009-1927  |  Open Access |  How to cite  | 


We herein discuss state-of-the-art topics on recent advances in three-dimensional (3D)/four-dimensional (4D) ultrasound in obstetrics. These advances include HDlive, HDlive silhouette, HDlive Flow, superb microvascular imaging (SMI), and SlowflowHD. HDlive produces realistic sculpture images of the fetus and placenta, while HDlive silhouette presents holographic images. HDlive Flow provides spatial 3D reconstructions of normal and abnormal fetal cardiovascular systems and placentas. 3D SMI and 3D SlowflowHD both shows the microvasculature of the fetal organs and the placenta. These techniques allow for novel visualization of normal and abnormal fetuses and placentas and a more detailed understanding of physiological and pathological conditions. 3D/4D ultrasounds have the potential to become important modalities in future clinical practice and research on the fetus and placenta.


Original Scientific Article

Kornelija Trajkova, Milena Petrovska, Aleksandar Dimovski, Biljana Curcic, Katerina Popovska Jankovic, Gordana Adamova

Molecular Analysis of Vaginal Microbiome in Women of Reproductive Age

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:11] [Pages No:107 - 117]

Keywords: Bacterial vaginosis, Lactobacillus, Molecular analysis, Vaginal microbiome

   DOI: 10.5005/jp-journals-10009-1932  |  Open Access |  How to cite  | 


Aim: Molecular analysis of the vaginal microbiome (VM) in terms of types of Lactobacilli and their role. Material and methods: Ninety-three women of reproductive age were included in a prospective cross-sectional study. A vaginal examination and collection of two vaginal swabs, first for Nugent score and second for molecular identification of Lactobacillus spp. and other bacteria were performed. Identification was done by polymerase chain reaction (PCR) amplification of 16S rRNK genes and sequencing for Lactobacillus types. Results: Twenty-two species of Lactobacillus have been identified, 13 types in all 51 participants of the normal flora (NF) group, 19 types in 95.6% intermediate group (IM) (n = 23), and only seven in 68.4% of women in bacterial vaginosis (BV) (n = 19) group. Three types were the most common: Lactobacillus iners, almost equally present in all three groups, predominantly as a single type and in combination with other pathogenic bacteria (Gardnerella vaginalis and two types of Mycoplasmataceae), and Lactobacillus crispatus and Lactobacillus casei, both significantly associated with NF. L. crispatus was more abundant in the secretory vs proliferative phase of menstrual cycle. Conclusion: Colonization with any Lactobacillus and especially L. crispatus and L. casei, is generally significantly associated with NF. L. iners is associated with dysbiosis. The molecular analysis of the VM may significantly participate in developing strategies for prevention and treatment of genital infections.



Taib Delić, Emina Smajić, Aleksandra Pašić, Vahidin Katica, Džihan Abazović, Dušica Petrović, Aleksandar Ljubic, Amela Kereš

Ovarian Tissue Microfragmentation and Exposure to Autologous Growth Factors In Vitro and Reproductive Outcome after Orthotopic Retransplantation

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:6] [Pages No:118 - 123]

Keywords: Growth factors, Orthotopic ovarian transplantation, Primary ovarian insufficiency, Sterility

   DOI: 10.5005/jp-journals-10009-1930  |  Open Access |  How to cite  | 


Generally speaking, it is estimated that infertility affects about 186 million people worldwide. Infertility is still considered to be a female social burden, even though male fertility can be regarded as a half, or even more, of all cases of global infertility. This review aims to analyze the literature regarding the influence of growth factors on ovarian tissue cells after in vitro exposure and the establishment of normal reproductive and endocrine function after retransplantation. Primary ovarian insufficiency (POI) is one of the possible causes of infertility in women, affecting about 1% of the general population. Some of the specifics of premature ovarian failure (POF) are amenorrhea, elevated gonadotropin levels in women under 40, and also hypoestrogenism. Procedures such as ovarian transplantations can in fact lead to fertility restoring and endocrine function restoring. Ovarian tissue transplantation can be put into two categories, based on the tissue type that is planned to be transplanted: as ovarian cortex transplantation or ovarian transplantation. The process of freezing-thawing ovarian tissue is well known and researched, but the usage of cryopreserved ovarian cortex in fertility restoration still remains a significant challenge. Total effects of growth factors must be explored to a larger extent, but it is certainly encouraging that the known results are, by this day, quite satisfying. The beneficial effect on later follicle development or fertility restoration has yet to be researched and fully established.



Maria Papamichail, Panos Antsaklis, Lara Spalldi Barisic, Sanja Malinac Malojčić

Investigation of Cardiac Remodeling and Cardiac Function on Fetuses with Growth Restriction: A Review

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:14] [Pages No:124 - 137]

Keywords: Cardiac morphology, Cardiac morphometry, Growth restriction

   DOI: 10.5005/jp-journals-10009-1928  |  Open Access |  How to cite  | 


Fetal growth restriction (FGR) is defined as failure to reach full growth potential in utero and in clinical routine, it is translated as estimated fetal weight (EFW) below the 10th percentile, according to the growth charts. FGR affects 7–10% of pregnancies and it is responsible for the vast majority of perinatal mortality and morbidity. Moreover, FGR is considered as a risk factor for long-term infirmities such as motor skills disorders, cognitive, memory, and neuropsychological impairment, immune disorders, and metabolic syndrome. Importantly, there is an increasing pool of data, suggesting that individuals who as fetuses suffered from FGR, are at high risk for cardiovascular disease (CVD) in adulthood, namely hypertension, atherosclerosis, coronary artery disease, and stroke. Changes in cardiac function and cardiac morphology can be assessed prenatally and especially according to the severity of FGR.



Aida Salihagic-Kadic

Preeclampsia: Still a Disease of Theories

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:10] [Pages No:138 - 147]

Keywords: Hypertension, Preeclampsia, Pregnancy

   DOI: 10.5005/jp-journals-10009-1922  |  Open Access |  How to cite  | 


Hypertensive disorders in pregnancy are responsible for more than 60,000 maternal deaths around the world each year, and cause complications in up to 12% of all pregnancies. Pregnancies complicated by preeclampsia show higher maternal and perinatal morbidity and mortality. Numerous theories exist attempting to explain the etiopathogenesis of preeclampsia. Preeclampsia may have early- or late-onset in pregnancy, with the same pathophysiology characterized by disturbed placental perfusion and endothelial dysfunction preceding the clinical manifestations. Causative therapy for preeclampsia is still missing, and the only effective therapy recognized so far is delivery, with expected recovery of pregnant women after 6 weeks. Early detection using general or specialized screening tests can reduce the consequences for health, especially in infants. This review has emphasized the multifactorial etiology of preeclampsia. Each of the cited etiological factors helps to elucidate the pathogenesis in some way—on the contrary, they also increase the need for the precise detection and understanding of the primary factors, which in most of the cases remain unknown. Therefore, based on the existing knowledge, preeclampsia may be considered as “disease of theories. ”The aim of the paper is to present the characteristics of pregnant women presenting with different types of preeclampsia, with an overview of the pathophysiological mechanism of the disease.


Case Report and Literature Review

Zorancho Petanovski, Emilija Petanovska Kostova, Irina Prodanova, Tamara Ivkovska, Gligor Dimitrov

2D/3D Ultrasound Findings of Uterine Carcinosarcoma: A Case Report and Literature Review

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:5] [Pages No:148 - 152]

Keywords: 2D ultrasound, 3D color Doppler transvaginal ultrasound, Uterine carcinosarcoma

   DOI: 10.5005/jp-journals-10009-1923  |  Open Access |  How to cite  | 


Uterine carcinosarcoma is an infrequent, yet an invasive malignant tumor of the uterus. We presented the case of a 76-year-old menopausal woman with the first sparse bleeding and ultrasound findings of a large polypoid formation filling the uterine cavity. Ultrasound, specially more advanced techniques as 3D ultrasound and 3D Color Doppler ultrasound provide very useful data not only in the recognition of tumor mass, but also in terms of the structure, differentiation and stage of the malignancy.


Case Report and Literature Review

Yoko Nishimura, Chika Homma, Chihiro Hirama, Yuriko Iwahata, Hideyuki Iwahata, Natsumi Furuya, Haruhiro Kondo, Junichi Hasegawa, Nao Suzuki

Fetal Intra-abdominal Umbilical Vein Varix: Prenatal Sonographic Diagnosis and Delivery Management

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:4] [Pages No:153 - 156]

Keywords: Fetal intra-abdominal umbilical vein varix, Prenatal ultrasound diagnosis, Thrombosis of varix, Umbilical venous Doppler

   DOI: 10.5005/jp-journals-10009-1925  |  Open Access |  How to cite  | 


The clinical significance of fetal intra-abdominal umbilical vein varix (FIUVV) remains unclear, and specific obstetric management protocols have not yet been established. The aim of the present report was to demonstrate a case of FIUVV resulting in favorable perinatal outcomes due to our clinical strategies. We suggest close management of cases with a fetal diagnosis of FIUVV, including detection of the venous thrombus, Doppler velocimetry, and continuous fetal heart rate (FHR) monitoring. The timing of delivery is arguable. Despite close fetal monitoring, unexpected acute fetal death occasionally may occur. We believe early delivery is considerable in order to obtain a healthy infant.



Chika Homma, Junichi Hasegawa, Natsumi Furuya, Yuriko Iwahata, Nao Suzuki

Placental Mesenchymal Dysplasia without Severe Maternal-fetal Complications

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:3] [Pages No:157 - 159]

Keywords: Disease, Maternal-fetal complications, Placental mesenchymal dysplasia

   DOI: 10.5005/jp-journals-10009-1924  |  Open Access |  How to cite  | 


Objectives: Placental mesenchymal dysplasia (PMD) is different from the hydatidiform mole histologically. Rare disease of PMD is often a mistaken diagnosis because of the similar multicystic sonographic findings. The aim of the present case report was to demonstrate characteristics of PMD. Case presentation: Pregnant woman was referred at 20 weeks of gestation because of suspicion of partial hydatidiform mole. Ultrasound revealed normal fetal growth without morphological anomaly, enlarged placenta attached to the anterior wall included large multiple cysts and dilated chorionic vessels. Maternal serum human chorionic gonadotropin level was 25,961 IU/L. Based on these results, diagnosis of PMD was made. After genetic counseling, patient elected to continue the pregnancy. With advancing gestation, placenta continued to be large and hydropic, but the fetal growth was within normal. Due to complication of pre-eclampsia at 37 weeks of gestation, she delivered a healthy female infant (2289 gm) and enlarged placenta weighed 1838 gm. Conclusion: Placental mesenchymal dysplasia that often complicates both maternal and fetal several abnormalities is one of the important perinatal disorders which required accurate ultrasound diagnosis and appropriate genetic counseling from the early gestation.



Kaoru Ito, Junichi Hasegawa, Yoko Nishimura, Natsumi Furuya, Chika Homma, Haruhiro Kondo, Nao Suzuki

Eventration of the Diaphragm in Trisomy 18: Providing Information and Helping Choose a Treatment and Management Plan with an Exact Diagnosis

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:3] [Pages No:160 - 162]

Keywords: Eventration of the diaphragm, Perinatal care, Trisomy 18

   DOI: 10.5005/jp-journals-10009-1926  |  Open Access |  How to cite  | 


Trisomy 18 is one of the most common aneuploidies, and its prognosis is controversial due to the low survival rate associated with it. Thus, intensive management and treatment strategies for this genetic trisomy syndrome are essential. Because patients with trisomy 18 exhibit severe neurodevelopmental delay in long-term survival, treatment strategies can be complex and difficult. This study describes a complex case of trisomy 18 with rapid changes and complications in the third trimester. These complications made differentiation between diaphragmatic hernia and diaphragmatic eventration on ultrasound difficult. Since this case was associated with rapid changes and required rapid delivery, close examination was not possible. Further, it is difficult to provide information and help decide whether to intervene without an exact diagnosis. In conclusion, an interdisciplinary team approach, including parental involvement, is vital for helping families to make appropriate decisions. For this reason, an accurate ultrasound diagnosis is necessary.



Bikramjit Singh Sidhu

Conjoined Twins: First Trimester Diagnosis at 9 Weeks

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:3] [Pages No:163 - 165]

Keywords: Conjoined twins, Early antenatal diagnosis, Ischiopagus, Monoamniotic-monochorionic twins

   DOI: 10.5005/jp-journals-10009-1931  |  Open Access |  How to cite  | 


Introduction: Conjoined twins are an extremely rare occurrence registered in 1:50,000 to 1:100,000 live births. Due to the increased risk of perinatal morbidity and mortality it is crucial to do the prenatal evaluation and early diagnosis of conjoined twins by ultrasound scan in the first trimester. Early diagnosis in the first trimester gives the parents an option of safe termination of pregnancy. Case report: A 27-year-old G2P1L1 female was referred to our department for routine first trimester antenatal ultrasound at 9 weeks 4 days according to last menstrual period (LMP). Ultrasound examination detected a monochorionic-monoamniotic twin pregnancy. The two fetuses were seen in a face-to-face fixed position with two separate fetal heads and chests seen. Two separate hearts were seen. The twins were found to be joined at the lower abdomen and pelvis. Based on ultrasound findings ischiopagus conjoined twins diagnosis was made. Parents were counseled and they opted for termination of pregnancy. Conclusion: Conjoined twins are a very rare complication of monoamniotic-monochorionic pregnancies. Diagnosis on antenatal ultrasound can be made, if in a twin pregnancy, both fetuses persistently maintain a fixed position relative to each other. Early antenatal diagnosis by ultrasound gives the parents a chance to choose an option of safe termination.



Erik Dosedla, Zuzana Ballová, Pavel Calda

Prenatal Diagnosis of Milroy's Syndrome

[Year:2022] [Month:April-June] [Volume:16] [Number:2] [Pages:4] [Pages No:166 - 169]

Keywords: DNA analysis, Lymphedema, Milroy's syndrome, Prenatal ultrasound, Vascular tissue, VEGF

   DOI: 10.5005/jp-journals-10009-1929  |  Open Access |  How to cite  | 


Aim: The aim of our case report is to display modern possibilities of prenatal diagnosis of different types of congenital lymphedemas compared to postnatal diagnostic options. Background: Milroy's syndrome (MS) or primary congenital lymphedema as the most common form of the group of hereditary primary lymphedemas. It is a rare condition and until these days FTL4 encoding vascular endothelial growth factor receptor 3 (VEGFR 3) is the only gene detected to be associated with MS. Case description: We present a case of prenatally diagnosed MS with its typical clinical manifestation and postnatally confirmed genetic background. What makes our case interesting is the curiosity behind the combination of proven features of lymphedema type 1A and by DNA analysis detected chromosomal aberrance as a fragile site at chromosome 16q22 which responds to another types of congenital lymphedema. Conclusion: MS has proven causality with hereditary defects in the gene encoding VEGFR 3 on 5q35.3. However, to date, no case of MS has been reported in which DNA analysis demonstrates the overlap of traits and features responded of other types of lymphedemas. Clinical significance: The reported case provides an opportunity for further investigation and understanding of the genetic background and pathophysiology of this rare condition.


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