HDlive Flow demonstrates three-dimensional (3D) cardiovascular structures with greater depth perception and dimension using a light source to create favorable lighting and shadowing effects. The supplemental usefulness of this technique for evaluation of the normal fetal heart and diagnosis of congenital heart anomaly in the second and third trimesters of pregnancy has been described. The potential advantages of HDlive Flow for the diagnosis of congenital heart anomaly need to be explored in the first trimester of pregnancy. In this pictorial essay, we present our experiences of the use of HDlive Flow to diagnose congenital heart anomalies in the first trimester of pregnancy.

Success of any assisted reproductive technology is chiefly dependent on two decisions—selection of correct stimulation protocol, and this needs to be tailor-designed for every patient ideally. Selection of correct stimulation protocol is based on prestimulation assessment of female to assess ovarian response and reserve. This is done by baseline ultrasound scan on 2nd–3rd day of menstrual cycle. Reserve relates to antral follicle count (AFC) or ultimate yield of follicles/ova at the end of stimulation, and this can be decided by AFC and ovarian volume, whereas response relates to sensitivity of ovary to ovulation stimulating agents to produce those follicles and this relates to ovarian stromal blood flow [resistance index (RI) and peak systolic velocity (PSV)]. Adding age and body mass index (BMI) to these parameters, a baseline scoring system has been developed that has been proven to be a safe and efficient way to decide stimulation protocols.

Uterine fibroids (UFs) or leiomyomas (LM) are common benign neoplasms of the uterus. UFs have many complications and can negatively affect the women's quality of life, and their management can get interventional. This review discusses the epidemiology, etiology, pathogenesis, and genetic origin of UFs as well as the contributing epigenetic factors to their development. We correlated some of the driving genetic factors of fibroids with their presentation or location on ultrasound clinically.

The female reproductive system in humans is a finely balanced highly dynamic hormonal system. Correct understanding of these hormonal orchestras is the basis of understanding the cause of infertility and it is the same understanding that helps to manage the treatment cycles optimally. This can be done by multiple hormonal assessments, but ultrasound is a very effective tool to monitor, follow, and understand these changes and this is sonoendocrinology. The vascular changes precede the morphological changes when hormonal changes occur. Correlating the morphological and vascular changes with their physiological and hormonal basis can interpret the hormonal changes occurring during the menstrual cycle.

Cervix is an important part of the uterus in obstetrics because that anatomical part withstands the pressure of the pregnant uterus until the moment of childbirth. Many mechanisms play a role in the beginning of labor, and it is fascinating how it is a harmonized mechanism. Unfortunately, under the influence of various factors, it leads to preterm labor (PTL) or preterm premature rupture of the fetal membranes (PPROM). Ultrasound is an ideal tool in detecting the status of the cervix during pregnancy. Vaginal ultrasound has shown better sensitivity and predictability than abdominal ultrasound. Regarding vaginal ultrasonography of the cervix in gynecology, recent studies show the effectiveness of vaginal ultrasound in the detection of cervical pathology. Not only in detection but transvaginal ultrasound (TVU), especially new techniques such as three-dimensional (3D) color Doppler, also helps clinicians in choosing the right therapeutic approach for malignant diseases of the cervix.

Perinatology emerged in the second half of the 20th century when the examination, care, and treatment of the fetus as a patient became possible before and during birth with various biochemical and biophysical methods. The life functions of preterm newborn infants could be maintained with intensive care therapy. Nowadays, the health and the life of pregnant and puerperal women as well as their fetuses/neonates can dominantly be supported by professionals in obstetrics, neonatology, and anesthesiology. Perinatology combines collaborative efforts from obstetrics, neonatology, and anesthesiology, along with intensive therapy for caring about the life and health of the mother and the fetal/neonatal patients. In this volume, the third pillar of the triangle of perinatal care is emphasized. Participation of obstetrical anesthesiologists in the process of indication, mode of anesthesia, and timing of operative delivery is essential. Preeclampsia/eclampsia/hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, and serious peripartum bleeding are the most common maternal and fetal life-threatening conditions, which require a high level of adult intensive care. The objective of this review is to prove the role of anesthesiology and intensive therapy as the third pillar of perinatal medicine in the management of great obstetrical syndromes.

There is also a continuity of fetal and neonatal movements, which are important indicators of developmental processes of the brain. The aim of the paper is to present neurological prenatal and postnatal assessment of behavior, which is affected by the continuity of general and other movements from prenatal to postnatal life. A prenatal neurological test has been developed using four-dimensional ultrasound (4D US) to assess isolated head anteflexion, eye blinking, facial and mouth movements, leg, hand and finger movements, cranial sutures, and general movement (GM) gestalt perception, all included in the Kurjak antenatal neurodevelopmental test (KANET). Neurological assessment should be continued postnatally as clinical investigation and assessment of Prechtl's GMs. Continuity of assessments relates to the continuity of fetal to neonatal movements, understanding which gives clinicians the opportunity for earlier detection of neurological disability. The diagnosis of cerebral palsy (CP) as the most severe neurological disability is retrospective, and it is exceptionally made before the age of 6 months in only the most severely affected infants; the specificity of the diagnosis will improve as the child ages and the nature of the disability evolves. Interest in the diagnosis of neurological impairment among experts using 4D US has recently shifted toward the prenatal period. Are we approaching the era of the development of diagnostic tests to detect nonreassuring fetal neurological status in its intrauterine life to intervene at appropriate times in order to decrease the CP rate? It is questionable if the KANET test could be the tool to achieve this desire.

Prematurity, which occurs in about 12% of pregnancies worldwide, continues to be one of the leading causes of perinatal morbidity and mortality worldwide. Preterm birth (PTB) can still be considered a syndrome with a variety of causes and underlying factors, which results in mostly unnoticed contraction of the uterus and changes in the cervix. Despite considerable effort aimed at decreasing the incidence of spontaneous PTB, PTB remains the leading cause of perinatal morbidity and mortality. In light of the available data, screening strategies for PTB are deficient. Approaches used to identify women considered by historical factors to be low risk for preterm delivery, as well as those at high risk for PTB, continue to evolve. Ultrasound evaluation of the cervix during pregnancy has been the focus of much research during the past decades. Cervical measurement by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous PTB in high- and low-risk singleton pregnancy. Cervical shortening, which is often detected on ultrasound examination before it can be appreciated on physical examination, is one of the first steps in the processes leading to labor and can precede labor by several weeks. This is likewise true for funneling and loss of cervical gland area, which cannot be assessed with the physical examination. Therefore, all of these markers, especially if they are used together, can be useful to predict PTB and start adequate therapy as soon as possible to prevent spontaneous preterm delivery.

Within the last 34 years, three-dimensional (3D) sonography has undergone enormous development in prenatal diagnostics. On the one hand, this concerns transducer technology, and on the other hand, optimization in ultrasound device ergonomics. Advances in computer technology have also made it possible to accelerate the computational steps required for 3D sonography in ultrasound devices. The different 3D display modes that are available today offer enormous additional potential in prenatal diagnostics, especially for the examiner experienced in two-dimensional (2D) sonography. In this way, 2D planes can be controlled in a targeted manner, and unclear or complex structures, as well as axis deviations, can be spatially displayed. Fetal malformations can thus be precisely depicted from different angles or specifically excluded. In particular, surface defects can thus be clearly demonstrated to the parents-to-be. The aim of this publication is to provide an overview of the development and potential of 3D ultrasound technology in prenatal diagnostics.

The field of genetic prenatal diagnosis has seen remarkable advances in terms of prevention of birth defects and genetic diseases in the last 40 years. This progress is due to the operators’ experience with new genome studies and molecular biology analysis. In the meantime, the most sophisticated ultrasonography equipment has made it possible to perform fetal procedures in early pregnancy as well as in the preimplantation period, thus making prenatal diagnosis increasingly accepted by couples wishing to plan their offspring and reducing the anxiety of waiting for the diagnostic response, and, in severe cases when chosen by the woman, the possibility of terminating the pregnancy in the first trimester. In the new era of genetic screening using combined tests and noninvasive prenatal testing (NIPT), we have had a decrease in invasive prenatal diagnostic procedures and a progressive increase in chorionic villus sampling (CVS) compared to amniocentesis for chromosomal indications. In this paper, we describe the invasive sampling techniques performed at Microcitemico Hospital–Cagliari in the last 40 years by fetal blood sampling (FBS), amniocentesis, CVS, and preimplantation genetic diagnosis (PGD) applied to prevent the most common fetal genetic disorders.

Objective: The aim of this study is to evaluate the normal and abnormal pericallosal artery (PCA) by three-dimensional (3D) ultrasonography and Doppler technologies. Additionally, it describes a systematic method on how to acquire and manipulate volumes for the precise demonstration of the PCA. Methods: With the use of the glass body mode (grayscale ultrasound and color or power Doppler), 3D ultrasound permits precise imaging of the fetal PCA, an important anatomic landmark of the corpus callosum. This rendering mode enables us to demonstrate sonographically the origin, course, and branching patterns of the PCA with the callosomarginal artery (CMA) as well as other fetal cerebral blood vessels and venous sinuses. Results: A step-by-step systematic approach to identifying the cerebral vasculature from ultrasonographic volume data sets was developed. The volumes were rotated into a standard anatomic orientation in the multiplanar display, and then, by systematic navigation, the PCA with its main branches was demonstrated. Conclusion: The use of 3D power Doppler sonoangiography enables the precise demonstration of the normal variants of the fetal brain vessels and provides knowledge about anatomical variations and the diversity of human brain anatomy. The knowledge of normal variants helps to detect pathological forms of brain vascularity.

Twin reversed arterial perfusion (TRAP), a rare condition (0.3:10,000) that occurs in monochorionic twin pregnancies, with the coexistence of a normal “pump twin” and an acardiac twin. The acardiac twin is parasitic, using an anomalous reversal of umbilical arterial flow. This anastomosis occurs in the 3rd–4th week of gestation, and the acardiac twin puts the pump fetus at risk of high-output cardiac failure. The pump twin has a mortality rate of up to 55%. Antenatal ultrasound recognition in the first trimester Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies aids in proper prenatal diagnosis. Presented is a 26-year-old woman, gravida para, who came to our hospital at 19th gestational week (GW). The first ultrasound showed a twin monochorionic/diamniotic pregnancy, with one normally developed fetus and an atypical mass without a heart. The patient was previously monitored elsewhere, but TRAP syndrome wasn't identified. We followed her until the 26th week, and she was later sent to a tertiary center for further conservative treatment in the absence of operative treatment in our country. The patient gave birth via C-section in the 32nd gestation week. The normal twin was born in good condition and was sent home after a few weeks.

The term, vein of Galen aneurysm, is related to a group of different vascular anomalies and may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Data indicate that the venous sac most probably represents the persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen. It represents a rear vascular anomaly, whose incidence is yet unknown, although some authors suggest numbers around 1:25000 deliveries. It accounts for only 1% of all intracranial malformations, but the percentage of this anomaly in pediatric populations is up to 30%. In most cases, the diagnosis is made postnatal, while antenatal diagnosis, because of the pathophysiology of the aneurysm itself, as well as the pathophysiology of its possible complications, is made usually during the third trimester. The earliest reported diagnosis was made at 25 weeks’ gestation. In the presence of vein Galen aneurysm malformations (VGAMs), high-output congestive heart failure with the development of fetal hydrops and hemispheric white matter injuries is a possible fatal outcome. They are associated with a poor outcome.

We present a case of partial hydatidiform mole with a coexistent live fetus in a twin pregnancy diagnosed early in the first trimester of pregnancy. At 6 weeks and 4 days of gestation, an early-stage nonhydropic mole (massive lobulated masses with intrauterine anechoic fluid collection) in one gestational sac (GS) and a viable embryo (crown-rump length = 4 mm) in another GS were identified. An inhomogeneous solid mass adjacent to the GS containing the viable embryo was noted at 8 weeks and 4 days. Blood flow was evident at the periphery of the solid mass with numerous focal vesicles at 10 weeks and 2 days. HDlive depicted numerous focal small vesicles in the solid mass and a viable fetus in the GS. HDlive Silhouette clearly showed a viable fetus in the GS adjacent to the solid mass containing numerous small focal vesicles and an umbilical cord attached to the normal placenta. The parents decided to terminate the pregnancy at 11 weeks and 3 days of gestation. The pathological diagnosis was a partial hydatidiform mole with a coexistent fetus (PHMCF). Chromosome analysis revealed 46, XY of the fetus, and 69, XXX of the hydatidiform mole. To the best of our knowledge, this is the first report of diagnosing a PHMCF early in the first trimester of pregnancy. Color Doppler and HDlive Silhouette might be useful adjunctive modalities to diagnose a partial hydatidiform mole with the coexistent fetus.