Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2023 | July-September | Volume 17 | Issue 3

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Toshiyuki Hata, Aya Koyanagi, Miyu Konishi, Toshiyuki Hata

HDlive Flow with HDlive Silhouette Feature of Isolated Fetal Pericardial Effusion at 17 Weeks of Gestation

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:3] [Pages No:181 - 183]

Keywords: HDlive Flow, HDlive Silhouette, Isolated fetal pericardial effusion, Radiant flow

   DOI: 10.5005/jp-journals-10009-1979  |  Open Access |  How to cite  | 


Objective: To present HDlive Flow with spatiotemporal image correlation (STIC) and HDlive Silhouette features of isolated fetal pericardial effusion (IFPE) detected at 17 weeks and 4 days of gestation. Case description: Two-dimensional sonography showed a sickle-shaped echo-free space (5.6 mm) located along the right-side of the fetal heart (atrioventricular groove) at 17 weeks and 4 days of gestation. Radiant flow revealed no flow inside the cyst. HDlive Flow and HDlive Silhouette clearly depicted the spatial relationship between a tadpole-shaped echo-free space and the fetal heart. The cyst disappeared at 24 weeks and 5 days of gestation. A healthy male neonate was delivered at 40 weeks and 4 days, and had no complications. There was no developmental or neurological disorder of the baby one year after birth. Conclusion: HDlive Silhouette may provide information on the spatial recognition and origin of an echo-free space of the fetus.


Original Article

Mohini Sethi, Sonal Panchal, Chaitanya Nagori

Evaluation of Baseline Scoring System in In Vitro Fertilization Cycles

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:13] [Pages No:184 - 196]

Keywords: Assisted reproductive technology cycles, Controlled ovarian stimulation, Ultrasound score

   DOI: 10.5005/jp-journals-10009-1980  |  Open Access |  How to cite  | 


Aims and Background: In vitro fertilization (IVF) is a method of assisted reproductive technology (ART) in which the ovary is stimulated using gonadotropins. The purpose of this study is to decide the optimum gonadotropin dose that would adequately stimulate the ovaries without leading to hyperstimulation syndrome or cycle cancelation due to understimulation. In this study along with the age and body mass index (BMI) of the patient, various ultrasound parameters have been used for tailoring the appropriate gonadotropin dose for every individual based on a baseline scoring system. Materials and methods: It was a retrospective study of 61 patients. All consenting patients between the age of 22 and 40 years and BMI between 18 and 34 who were taken for IVF/intracytoplasmic sperm injection (ICSI) cycles by virtue of tubal factor infertility, male factor infertility, dysovulatory infertility (including polycystic ovarian syndrome (PCOS)] and unexplained infertility were included in the study. The baseline scoring system parameters were assessed in relation to the dose of recombinant follicle- stimulating hormone (rFSH) given, luteinizing hormone (LH) supplementation dose added at different times in the cycle, the need to change the dose of gonadotropins, various size ranges of follicles on the day of trigger and their ultimate relation with M2 oocytes retrieved. Results: Only one patient required a change of dose of gonadotropins. There was no ovarian hyperstimulation or cycle cancelation. There was a significantly higher number of M2 oocytes retrieved in patients where LH supplementation was not done, irrespective of dose or day of addition of LH. There was also a strong positive correlation between follicles 10–15 mm on the day of trigger and the number of prophase oocytes retrieved. Conclusion: The baseline scoring system is an accurate and reliable method for deciding the dose of gonadotropins in IVF stimulation protocols. The addition of human menopausal gonadotropin (HMG) to rFSH anytime in the cycle at any dose does not show improvement in the number of M2 oocytes retrieved and its use should be judicial. Retrieval of follicles <15 mm may not result in M2 oocytes and so may not be beneficial. Clinical significance: To individualize the stimulation dose in IVF cycles, other than age and BMI, other ultrasound parameters like antral follicle count (AFC), ovarian volume, and ovarian stromal Doppler studies should be used. This can avoid hyperresponse and cycle cancelation.



Dipansha Bajpai, Deepa Shanmugham, Prithviraj Nagarajan, Leena Rajathy P Louis

A Comparative Study of Clinical, Radiological, Hormonal, and Metabolic Parameters between Nonobese and Overweight Polycystic Ovarian Syndrome (PCOS) Patients

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:5] [Pages No:197 - 201]

Keywords: Acne, Hirsutism, Luteinizing hormones, Obese, Polycystic ovarian syndrome

   DOI: 10.5005/jp-journals-10009-1983  |  Open Access |  How to cite  | 


Background: One in five women of reproductive age-group is affected by polycystic ovarian syndrome (PCOS). The high prevalence of PCOS makes it of immense clinical and public health importance. This study is aimed to compare the clinical, radiological, hormonal, and metabolic parameters of nonobese and overweight PCOS patients. Aim: This prospective observational study is aimed to compare the clinical, radiological, hormonal, and metabolic parameters of nonobese and overweight PCOS patients. Materials and methods: This prospective observational study is conducted among the patients attending the outpatient department (OPD) diagnosed with PCOS according to Rotterdam's criteria among females aged 15–45 years (reproductive age-group). A total of 57 participants are included in the study. All participants fulfilled the inclusion criteria and informed consent was obtained. Results: The mean age of participants was found to be 22.3 ± 4.4 years of age. There was a significantly higher mean weight and waist-hip ratio among the group II participants compared to group I (p < 0.05). The mean level of luteinizing hormones (LH) among group II was 11.81 ± 4.67 and group I was 10.58 ± 4.47 (p > 0.05) and thyroid-stimulating hormone (TSH) levels were 2.93 ± 1.91 among group II and 3.07 ± 2.12 among group I participants (p > 0.05). The mean stromal volume of the right ovary in group II was 13.5 ± 4.2 and in group I was 12.2 ± 3.4 and of the left ovaries, it was 12.05 ± 3.05 in group II and 11.30 ± 2.78 in group I participants (p > 0.05). The significantly higher mean of total cholesterol among group II (170.7 ± 22.7 mg/dL) compared to group I participants (155.8 ± 21.1 mg/dL) (p < 0.05). Hirsutism was significantly higher among group II participants (27.8%) compared to the participants in group I (p < 0.05). Conclusion: It was found that there is a significant difference in the metabolic parameters and clinical characteristics in the PCOS women of both groups and also a significantly higher incidence of hirsutism among the obese PCOS participants, as well as a higher incidence of other clinical parameters.



Eberhard Merz, Sonila Pashaj

Embryonic and Early Fetal Abnormalities Diagnosed with Three-dimensional Ultrasound in the First Trimester

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:15] [Pages No:202 - 216]

Keywords: Fetal malformations, First trimester, Four-dimensional ultrasound, Prenatal diagnosis, Three-dimensional ultrasound

   DOI: 10.5005/jp-journals-10009-1987  |  Open Access |  How to cite  | 


Compared to two-dimensional (2D) ultrasonography, three-dimensional (3D)/four-dimensional (4D) ultrasound allows the examiner and the parents-to-be to visualize normal embryonic and early fetal development in a completely new way. In particular, with a high-resolution transvaginal 3D/4D probe in the 3D surface mode, important anatomical details can already be seen in the first trimester, just like in a photo. With 4D sonography, movements of the embryo/fetus can also be detected without motion artifacts. As part of a targeted early diagnosis of malformations, the experienced operator can already detect a certain number of larger defects, which means that clinical consequences can be drawn much earlier. Likewise, in the event of a risk of recurrence of a certain malformation, a normal finding can be convincingly demonstrated to the expectant parents at an early stage. Nevertheless, it must be taken into account, however, that various fetal malformations cannot yet be detected in the first trimester even with 3D sonography, which is why a further targeted malformation examination in the 2nd trimester cannot be dispensed with.



Joseph G Schenker

Preembryo: Medical, Moral, and Legal Aspects

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:6] [Pages No:217 - 222]

Keywords: Ethics, In vitro fertilization, Preembryo, Synthetic gametes and embryos

   DOI: 10.5005/jp-journals-10009-1982  |  Open Access |  How to cite  | 


The preembryo refers to the early stage of human development following fertilization but before implantation in the uterus, typically up to about 14 days old. The moral status of the human preembryo is a subject of ethical and philosophical debate Some argue that the preembryo should be accorded full moral status and rights from the moment of fertilization, considering it as a human being. with the same moral values and rights as any other person. This perspective is often rooted in religious or philosophical beliefs that attribute personhood to the zygote, on the opposite end of the spectrum, some argue that the preembryo lacks moral status and that considerations about moral standing and rights are only applicable to more developed entities with consciousness and sentience. The legal status of preembryos is closely tied to regulations governing assisted reproductive technologies (ART) and embryonic research. In countries where embryonic research is allowed, the legal status of preembryos used for research purposes may be subject to specific regulations and oversight. These regulations often aim to strike a balance between advancing scientific knowledge and respecting ethical considerations. Recently stem cell research and developmental biology have opened up possibilities for generating synthetic gametes, also known as in vitro gametogenesis, which refers to the process of generating functional sperm and eggs outside of the human body through cellular reprogramming or other techniques. June 2023, the possibility of generating artificial embryos from stem cells. The aim is to understand early human development better and potentially use this knowledge to treat various medical conditions and advance reproductive technologies. The present scientific achievements create concern around the potential misuse of this technology, as well as questions about the moral status of these synthetic embryos and the implications for human life.



Liliana S Voto, Norberto D Margulies

Diagnosis and Treatment of Fetus Anemia: Current Status

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:11] [Pages No:223 - 233]

Keywords: Fetal Anemia, Fetal-neonatal morbidity, Mortality

   DOI: 10.5005/jp-journals-10009-1986  |  Open Access |  How to cite  | 


Fetal anemia is defined as the diminished concentration of fetal hemoglobin below two standard deviations for gestational age. In Argentina as well as in most developing countries, this disease is one of the leading causes of fetal-neonatal morbidity and mortality (5% of perinatal deaths) due to the lack of appropriate prophylaxis with postpartum anti-D γ-globulin and inadequate prenatal control. Fetal anemia is originated in the mother due to the presence of specific antibodies–originated In Rhesus factor (Rh)—negative mothers whose husbands are Rh-positive and whose immunization occurred during pregnancy, abortion, postpartum or incompatible transfusions that pass through the placenta agglutinate and hemolyze fetal red blood cells, thus causing fetal anemia and hemolytic disease. In the most severe cases, the fetus can be hydropic or die in utero due to congestive cardiac failure. In our experience, the immunization frequency in Rh-negative patients during their second pregnancy with compatible Rh-positive fetuses is 12–15%. The cornerstone of the follow-up of the sensitized Rh-negative woman is a composite of an appropriate anamnesis, the indirect Coombs test, titration of anti-D antibodies, ultrasound (US) middle cerebral artery (MCA) peak systolic velocity, amniotic fluid spectrophotometry, amniocentesis/cordocentesis, and antenatal fetal monitoring. The pillar of the treatment of severe maternal-fetal Rh-incompatibility to prevent fetal death and allow the fetus to reach viability is intrauterine fetal transfusion (by the intraperitoneal route or intravascular fetal transfusion), high intravenous dose immunoglobulin (HDIVIg) as a single treatment or followed by intrauterine transfusions (IUTs). The neonatal treatment of the newborn is based on phototherapy and HDIVIg, which reduce the frequency of neonatal transfusions needed and the bilirubin maximum levels.



Jing Deng

Nomenclature of Three-dimensional and Four-dimensional Ultrasound in Obstetrics, Gynecology, and Fetal Echocardiography

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:14] [Pages No:234 - 247]

Keywords: Fetal echocardiography, Nomenclature, Obstetrics and gynecology, Three-dimensional and four-dimensional, Ultrasound

   DOI: 10.5005/jp-journals-10009-1985  |  Open Access |  How to cite  | 


This article attempts to define various three-dimensional (3D) or four-dimensional (4D) terms with rationales behind these definitions and with a focus on most frequently but often inconsistently or misused terms. It is based on the author's own 3D/4D experiences and a review of related literature.



Hans P Dietz

Three-dimensional/Four-dimensional Pelvic Floor Ultrasound

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:22] [Pages No:248 - 269]

Keywords: Avulsion, Birth trauma, Four-dimensional ultrasound, Levator ani, Obstetric anal sphincter injury, Pelvic organ prolapse, Ultrasound

   DOI: 10.5005/jp-journals-10009-1984  |  Open Access |  How to cite  | 


Ultrasound is the primary imaging method in gynecology, and it is also widely used in urology and colorectal surgery. This makes the modality increasingly popular in the imaging assessment of pelvic floor anatomy, a field all three specialties are routinely involved with. This development is long overdue, especially as pathophysiology and etiology of most pelvic floor conditions are still poorly understood. The advent of three-dimensional (3D) ultrasound allows access to the axial plane and arbitrarily definable parasagittal and oblique planes which has greatly facilitated the assessment of the levator ani muscle, the anal sphincter, and of paraurethral abnormalities such as urethral diverticula. At least as importantly, four-dimensional (4D) ultrasound enables the observation of function in the form of maneuvers such as cough, Valsalva, and pelvic floor muscle contraction.



Giuseppe Rizzo, Victoria Bitsadze, Alessandro Quarto, Alexander Makatsarya, Ilenia Mappa

First-trimester Placenta Volume and Three-dimensional Vascularization

[Year:2023] [Month:July-September] [Volume:17] [Number:3] [Pages:7] [Pages No:270 - 276]

Keywords: Fetal growth restriction, Maternal smoking preeclampsia, Placenta, Placental vascularization, Placental volume, Three-dimensional ultrasonography

   DOI: 10.5005/jp-journals-10009-1981  |  Open Access |  How to cite  | 


The relationship between placental size and its vascularization and perinatal pathology is well recognized. First-trimester assessment of placental volume and vascularization may predict birthweight and outcome of pregnancy. The size of the placenta can be determined by three-dimensional (3D) ultrasonography and by superimposing power Doppler (PD) its vascularization can be reliably reproduced. In this chapter, we will review the technique of obtaining placental volume and vascularization, the methodology of analysis of acquired volume, and their potential clinical applications.


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