Donald School Journal of Ultrasound in Obstetrics and Gynecology

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2024 | January-March | Volume 18 | Issue 1

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Toshiyuki Hata, Miyu Konishi, Aya Itoh, Riko Takayoshi, Takahito Miyake, Naoki Okimoto, Yasuo Nakahara

Three-dimensional Ultrasound, HDlive, HDlive Silhouette, and SlowflowHD Features of Fetal OEIS Complex in the First-trimester of Pregnancy

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Fetus, First trimester, HDlive, HDlive silhouette, Omphalocele-exstrophy-imperforate anus-spinal defects complex, SlowflowHD, Three-dimensional ultrasound orthogonal rendering

   DOI: 10.5005/jp-journals-10009-2009  |  Open Access |  How to cite  | 


Objective: To demonstrate first-trimester ultrasound features of omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex using three-dimensional (3D) ultrasound orthogonal rendering, HDlive, HDlive silhouette, and SlowflowHD. Case description: A 34-year-old pregnant Japanese woman, G2, P1, was referred to our ultrasound clinic at 12 weeks and 6 days of gestation because of a suspected fetal extra-abdominal tumor. Two-dimensional (2D) sonography revealed an extra-abdominal tumor containing the stomach, liver, and intestines. 3D ultrasound orthogonal rendering revealed bladder exstrophy beneath the omphalocele and suspected thoracolumbar vertebral deformity. Ductus venosus blood flow velocity waveform was normal. HDlive and HDlive silhouette depicted bladder exstrophy beneath the omphalocele. HDlive silhouette revealed the stomach, liver, and intestines inside the tumor. SlowflowHD demonstrated characteristic intratumoral vascularity vascularity. OEIS complex was strongly suspected. Chromosome analysis using amniocentesis at 16 weeks and 4 days revealed a karyotype of 46, XY. Absent bladder and absent target signs were noted in the second- and third-trimester fetal ultrasound scans. Magnetic resonance imaging (MRI) in the third trimester revealed omphalocele with pubic symphysis diastasis and lower abdominal wall defect. At 38 weeks and 6 days of gestation, a cesarean section was performed, resulting in a male newborn weighing 2686 gm and with a height of 45.4 cm. Apgar scores were 7 (1 minute) and 8 (5 minutes), and umbilical artery (UA) blood pH was 7.318. OEIS complex was confirmed after birth. Conclusion: Three-dimensional (3D) ultrasound orthogonal rendering, HDlive, HDlive silhouette, and SlowflowHD may provide additional useful information about the unique characteristics of the OEIS complex in the first trimester of pregnancy.


Original Article

Lemana Spahić, Asim Kurjak, Milan Stanojevic, Almir Badnjević, Lejla Gurbeta Pokvić

Trustworthiness of Four-dimensional Ultrasound and Artificial Intelligence in Improving KANET Test for Detection of Fetuses at Neurorisk

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:11] [Pages No:6 - 16]

Keywords: Convolutional neural networks, Fetal neurological risk, 4D ultrasound, KANET, TRUEAID

   DOI: 10.5005/jp-journals-10009-2011  |  Open Access |  How to cite  | 


Background: Fetal neurological impairment disorders, encompassing conditions like cerebral palsy, epilepsy, and autism spectrum disorder, can result from various factors affecting fetal nervous system development. Timely diagnosis of these disorders is challenging but crucial for early intervention. Recent advancements in deep learning and ultrasound technology present an opportunity to develop a tool for early detection. Objective: This study aims to leverage convolutional neural networks (CNNs) to analyze fetal neurobehavioral movements in ultrasound images, with the goal of aiding in the early detection of neurological impairment disorders. Materials and methods: The study utilized a dataset of 3D ultrasound images extracted from 4D recordings of fetuses undergoing the Kurjak Antenatal Neurodevelopmental Test (KANET) during the third trimester. The methodology relies on the application of deep learning, more specifically convolutional neural networks (CNN) for the purpose of recognizing characteristic fetal movements. Results: The custom CNN architecture achieved an overall accuracy of 93.83%. The system was visualized by means of designing a graphical user interface that includes the developed model that works in the background every time a frame of a recorded 4D ultrasound video is deemed to be parsed through the system. Notably, distinguishing between facial and hand-to-face movements proved challenging. This pilot study lays the foundation for AI-based fetal neurological risk assessment, providing a promising tool for the early detection of fetal neurological impairment disorders. Conclusion: While acknowledging limitations such as class imbalance and the absence of differentiation between specific facial expressions, the study demonstrates the potential of AI in enhancing prenatal care. Future work will involve expanding the dataset, conducting real-time clinical validations, and further refining the model. The research holds implications for improving outcomes for affected children and making advanced diagnostic capabilities accessible in diverse healthcare settings.



Asim Kurjak, Milan Stanojevic, Lemana Spahić

Cerebral Palsy: Obstetrics and Neonatal Acute Problem

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:17] [Pages No:17 - 33]

Keywords: Cerebral palsy, Fetal neurobehavior, Kurjak antenatal neurodevelopmental test, Obstetrician, Neonatologist, Responsibility

   DOI: 10.5005/jp-journals-10009-2012  |  Open Access |  How to cite  | 


During the past 20 years, significant advances have been made in better understanding of the complex problem of cerebral palsy (CP). The most significant contribution has been made by the introduction of our Kurjak antenatal neurodevelopmental test (KANET), which in many multicentric studies proved to be successful in separating healthy fetuses from those with CP and other neurological problems. In this review article, we tried to review present knowledge on CP.



Helena Dukić

Music and Ultrasound: Origins of Our Emotional Connection to Music

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:11] [Pages No:34 - 44]

Keywords: Cognitive abilities, Emotional response to music, Fetus, Music

   DOI: 10.5005/jp-journals-10009-2004  |  Open Access |  How to cite  | 


Initially, this article will present the most relevant and up-to-date research that explores the influence of music on fetal development. Our investigation will commence with an analysis of studies examining the progression of fetal responses at different stages of gestation. Following that, we will scrutinize research pertaining to how fetuses react to music, both when it is played to them via their mothers and when it is presented directly to them. Lastly, we will consider studies that focus on fetal memory in the context of music. The second part of the article will focus on the reasons behind music's profound effects on fetuses. Why does music influence a fetus in numerous ways? What is the purpose of children being born with a developed predisposition for emotional responses to music? Several psychological and musicological theories provide various interpretations regarding the genesis of our connection with music, namely Parncutt and Chuckrow's theory of prenatal origin of music and Narmour's implication and realization model. This article will delve into these, aiming to connect them with the medical discoveries and results presented in the first part of the text.



Ulla Marton, Asim Kurjak, Milan Stanojevic

Chorionic Villus Sampling

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:8] [Pages No:45 - 52]

Keywords: Amniocentesis, Aneuploidy, Chorionic villi sampling, Genetic counseling, Prenatal diagnosis, Ultrasound

   DOI: 10.5005/jp-journals-10009-2005  |  Open Access |  How to cite  | 


Rapid improvements in the field of prenatal medicine have been achieved due to the technological advancement of ultrasonography that has allowed recognition of various ultrasonographic findings and their combination with biochemical results and demographic characteristics in order to estimate a final individual risk for a chromosomal anomaly of the fetus and analysis of short fragments of fetal DNA released into the mother's bloodstream through a natural process of cell death. Invasive testing still remains the main clinically available diagnostic modality for the definite diagnosis of both chromosomal anomalies and many single-gene disorders. Amniocentesis is performed between 15 and 20 weeks of pregnancy to obtain fetal cells for genetic testing. This method is performed almost in the middle of pregnancy, and waiting for the results of the analysis may indicate termination of pregnancy in the second trimester. Chorionic villus sampling (CVS), usually performed between 11+0 and 13+6 weeks of gestation, is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. Invasive procedures such as CVS and amniocentesis still remain the only definitive diagnostic tests for aneuploidy in pregnancy. CVS, as an invasive procedure carried out with experienced physicians in specialist centers, is not associated with a significant increase in fetal loss rate, with a risk rate below 0.5%, and the possible background risk for miscarriage is significantly higher in the presence of fetal anomaly and abnormal karyotype. Ultrasound-guided transabdominal (TA) CVS is a useful outdoor procedure and is considered the method of choice for fetal sampling and accurate early prenatal diagnosis.



Zorancho Petanovski, Asim Kurjak

Differential Diagnosis and Detection of Malignancy of Ovarian Tumors

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:12] [Pages No:53 - 64]

Keywords: Ovarian cancer, Three-dimensional/four-dimensional ultrasound, Two-dimensional/three-dimensional color Doppler

   DOI: 10.5005/jp-journals-10009-2010  |  Open Access |  How to cite  | 


Ovarian cancer is the most common cause of death compared to other cancers. The development of ultrasonography has brought great progress in terms of detecting ovarian pathology. This is very important not only in order to detect malignant potential as early as possible but also to choose an adequate approach to treatment in women who have not completed their reproduction. The devastating fact is that around 65% of women with ovarian cancer have advanced disease (stage III/IV) at diagnosis and certainly a much lower survival rate in comparison with patients who have detected stage IA ovarian cancer, whose 5-year survival is over 90% of cases. Due to this fact, for decades, there has been a strong effort to improve the ultrasound findings in order to detect changes in the ovary and to establish markers that enable the recognition of the malignant potential of tumoral changes in the ovary. Three-dimensional/four-dimensional (3D/4D) ultrasound and color Doppler techniques should bring a new quality to the recognition of pathological changes in the ovaries. These new techniques should bring the most accurate preoperative diagnosis of ovarian tumor changes and definitely the intention to detect ovarian cancer at the earliest stage of the disease, which is central to decisions regarding clinical management and surgical planning.



Zorancho Petanovski

Three-dimensional Ultrasound in Early Pregnancy—Part I: Pathological Conditions Affecting Early Pregnancy

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:8] [Pages No:65 - 72]

Keywords: Congenital uterine anomaly, Early pregnancy three-dimensional ultrasound, Ectopic pregnancy, Isthmocele, Myoma, Three-dimensional color Doppler

   DOI: 10.5005/jp-journals-10009-2014  |  Open Access |  How to cite  | 


The introduction of ultrasound in the detection of pregnancy brought a revolution in the analysis of possible pathology, already in the early stage of the development of the embryo and fetus. Congenital uterine anomalies have a negative impact on the reproductive potential of women and also increase fetal and maternal morbidity and even mortality, especially in the fetus during pregnancy and delivery. The association of myoma and pregnancy is becoming more frequent due to the increasing age of the first pregnancy. It may affect the outcome of fertility, pregnancy, labor, and peripartum course. The isthmocele is a myometrial defect resembling a pouch on the anterior wall of the uterine isthmus over a previous cesarean scar. The increase in the incidence of isthmocele is the result of an increase in the percentage of births completed by cesarean section, which has been a trend over the last decades. Due to the increased use of high-resolution ultrasound, around 80% of ectopic pregnancies are diagnosed before rupture, and >50% are diagnosed in asymptomatic patients. Two-dimensional (2D) and three-dimensional (3D) ultrasound identification of an adnexal mass, empty uterine cavity, and positive pregnancy test are gold standards for diagnosis. The advancement of ultrasound with the introduction of new techniques such as 3D ultrasound, 3D color Doppler, and power color Doppler brings a new quality to detecting potential pathology already in the early stages of pregnancy.



Emilija Petanovska Kostova

Three-dimensional Ultrasound in Early Pregnancy—Part II: Quantity and Quality of Early Pregnancy

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:12] [Pages No:73 - 84]

Keywords: Early pregnancy three-dimensional ultrasound, Embryo anembryonic pregnancies, Gestational sac, Missed abortion, Three-dimensional color Doppler, Yolk sac

   DOI: 10.5005/jp-journals-10009-2013  |  Open Access |  How to cite  | 


The use of ultrasound in early pregnancy provides very useful data on establishing an accurate gestational age, quality, and development of early pregnancy, but also the detection of conditions related to pregnancy itself, such as twin pregnancy. The most important structure that confirms a potential normal intrauterine pregnancy and is recognized on ultrasound in the 6th gestational week is the embryonic pool, which appears as a hypoechoic structure immediately adjacent to the yolk sac. The embryonic period ends in the 9th gestational week, and the fetal period begins. Certain suspicions for the existence of anomalies in embryos are proven in the fetal period. In the 9th gestational stage, the fugue of the embryo elongates, and the extremities are already clearly visible. After 12 weeks of gestation, ultrasound is a powerful tool in the definitive detection of fetal anomalies. Screenings to detect anomalies and tests that talk about intrauterine physiology and pathology of the fetus have already been established for this. Certainly, the main goal is to bring into the world a newborn alive and capable of living. Regarding spontaneous interruptions of early pregnancy, two types are differentiated: blighted ovum or anembryonic pregnancies and missed abortion.



Edin Medjedović, Asim Kurjak

Congenital Pulmonary Airway Malformation

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:4] [Pages No:85 - 88]

Keywords: Case report, Congenital abnormalities, Cystic adenomatoid malformation of lung, Ultrasound

   DOI: 10.5005/jp-journals-10009-2006  |  Open Access |  How to cite  | 


Congenital pulmonary airway malformation (CPAM) is a hamartoma-like lesion characterized by a polycystic mass of lung tissue with abnormal bronchial proliferation. It is the most frequent congenital thoracic malformation, accounting for 30–47% of fetal thoracic lung lesions. The exact pathogenesis is still unknown. Comorbidities associated with CPAM include pulmonary sequestration, lung malignancy, polyhydramnios, fetal hydrops, agenesis of the corpus callosum, congenital nephrotic syndrome, cleft lip and cleft palate, renal agenesis, esophageal atresia, diaphragmatic hernia, cardiovascular, and skeletal defects. Histopathological classification consists of five types of lesions; however, the most common clinical practice is to describe the CPAM lesion as microcystic (<5 mm) or macrocystic (>5 mm) and state its size. Microcystic lesions are associated with fetal hydrops and have a poor prognosis, whereas macrocystic lesions are usually not associated with hydrops and have a favorable prognosis. Ultrasound (US) scans every 2 weeks are recommended to monitor growth, lung lesions, and amniotic fluid volume for possible complications. Around 40% of CPAMs increase with the gestational age and stabilize around 26 weeks of gestation; however, in some cases, these lesions may continue to grow late into the third trimester. Fetal hydrops occur in about 5% and are associated with a close to 100% mortality rate. In cases of fetal hydrops, prenatal interventions may allow survival to birth. In the absence of contraindications, term delivery is recommended at a tertiary care center. In cases of poor growth, fetal hypoxia, or hydrops, earlier delivery is recommended for immediate postpartum treatment. About 70% of the children are asymptomatic at birth. For symptomatic infants, surgical resection is the management of choice.



Edin Medjedović, Milan Stanojevic, Sabaheta Jonuzovic-Prosic

Transposition of the Great Arteries

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:4] [Pages No:89 - 92]

Keywords: Congenital heart defect, Transposition of great vessels, Ultrasound

   DOI: 10.5005/jp-journals-10009-2007  |  Open Access |  How to cite  | 


Transposition of the great arteries (TGA) is a conotruncal abnormality characterized by discordant ventriculoarterial alignments, with the aorta arising from the right ventricle and the pulmonary artery arising from the left ventricle and resultant parallel circulation of the systemic and pulmonary circuits. TGA can be dextro-TGA or levo-TGA based on the position of the aortic valve, right or left, regarding the pulmonary valve, and simple or complex TGA based on associated cardiac anomalies. With an incidence of 0.2–0.3/1,000 live births, TGA is the secondmost common cyanotic heart disease following the tetralogy of Fallot. Around 98% of TGA cases have a normal four-chamber view (4CV). The International Society of Ultrasound in Obstetrics and Gynecology and the American Institute of Ultrasound in Medicine added evaluation of the outflow tracts, three-vessel view (3VV), and three-vessel trachea view (3VTV) which improved the sensitivity of ultrasound screening for congenital heart disease (CHD). However, the prenatal detection rate of TGA, especially simple TGA, is generally low internationally, ranging from 25 to 50%. Without treatment, 50% of these infants die within the 1st month and 90% within the 1st year of life. The prenatal diagnosis of TGA improves postnatal outcomes through planned delivery at a tertiary care center and timely perinatal management. Immediately after birth, prostaglandin-E1 is given to keep the ductus arteriosus open to allow the mixing of oxygen-rich and oxygen-poor blood. If necessary, an atrial septostomy can be performed for short-term survival. Arterial switch operation (ASO) restores normal pulmonary and systemic circulation, with a 20-year survival rate of 90–97%.



Toshiyuki Hata, Tomomi Kawahara, Riko Takayoshi, Takahito Miyake, Yasuo Nakahara

Multicystic Dysplastic Kidney of Fetus in First Trimester of Pregnancy

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:3] [Pages No:93 - 95]

Keywords: Case report, Fetus, First trimester, HDlive silhouette, Multicystic dysplastic kidney, SlowflowHD

   DOI: 10.5005/jp-journals-10009-2008  |  Open Access |  How to cite  | 


Objective: To demonstrate two-dimensional (2D) sonographic and HDlive Silhouette features of fetal unilateral multicystic dysplastic kidney (MCDK) in the first trimester of pregnancy. Case description: Mild pyelectasis of the left kidney (MCDK) was evident using 2D sonography, whereas two small cysts with pyelectasis were identified using HDlive silhouette at 11 weeks of gestation. Numerous small cysts were noted in MCDK using both techniques at 13 weeks’ gestation. Conclusion: HDlive Silhouette could provide novel information on detecting MCDK in the first trimester of pregnancy.


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