[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:1] [Pages No:0 - 0]
DOI: 10.5005/dsjuog-5-3-v | Open Access | How to cite |
Pregnancy and Uterine Anomalies
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:5] [Pages No:187 - 191]
Keywords: Uterine malformation,Pregnancy
DOI: 10.5005/jp-journals-10009-1195 | Open Access | How to cite |
Abstract
Congenital uterine malformations are known to have a higher incidence of infertility, repeated first trimester spontaneous miscarriages, fetal intrauterine growth restriction, fetal malposition, preterm labor, retained placenta and increased cesarean section rate. The actual incidence of uterine malformation is unknown, since many women do not have any symptoms. They are estimated to occur in 0.4% (0.1-3%) of the general population and in 4% of infertile women, and in patients with repeated spontaneous miscarriages the figures fluctuate between 3 and 38%. The discrepancy among different publications stems from their use of different diagnostic techniques, heterogenous population samples and clinical diversity of Mullerian anomalies.
Ultrasound and Diagnosis of Fetal Anomalies
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:12] [Pages No:193 - 204]
Keywords: Ultrasound,Fetal anomalies,Congenital abnormalities
DOI: 10.5005/jp-journals-10009-1196 | Open Access | How to cite |
Abstract
Congenital abnormalities account 20 to 25% of perinatal deaths. Now, many genetic and other disorders can be diagnosed early in pregnancy. Screening examinations during pregnancy are an essential part of prenatal care. Among the various screening tests that are now offered to pregnant women, ultrasound (US) has the broadest diagnostic spectrum. There is no modality that can detect as many abnormalities during pregnancy as US. A priority goal in screening is the early detection of major fetal anomalies, which are defined as malformations that affect fetal viability and/or quality of life. During the past 10 years, some multicentric studies in Europe and USA show the successfulness of US diagnostics in detecting congenital abnormalities, even in women with low-risk pregnancy. The term sonoembryology designates the description of the embryonic anatomy, the normal anatomic relations and the development of abnormalities as visualized by ultrasound. To confirm the presence of normal anatomy or to make the diagnosis of an anomaly, we need knowledge of the normal embryonic development, including the appearance of the normal embryo. Any deviation from the normal range during morphogenesis, constitutes an anomaly. Major anomalies are malformations that affect viability and/or the quality of life and require intervention, and minor anomalies are malformations that are definitely present, but are minimal and usually have no functional significance (e.g. ear tags). Incidence data on major congenital anomalies vary considerably, depending on the type of detecting system used. The passive detection system reports 2 to 3% of newborns, meanwhile the active detection system, in which newborns are systematically examined by trained obstetricians, reports the incidence of congenital defects in 7.3% of all newborns. About 20% of anomalies in live-born infants are based on a defective gene, 10% are due to chromosomal abnormalities and 10% are mainly due to exogenous injury to the conceptus. Some 60% of all congenital anomalies are indeterminate or multifactorial causes (hereditary factors and environmental influences). US can detect about 74% of major birth defects and possibly a higher number, when conducted by a well-trained specialist. We have demonstrated in this paper some fetal anomalies found by US during our practice in Tirana and Prizren. There are some anomalies of the CNS, neural tube defects, anomalies of the head, neck and spine, thoracic and cardiac anomalies, gastrointestinal and urinary tract anomalies as well as some extremities anomalies. US diagnostic is a very useful method for evaluating the fetal health, fetal anomalies, anomalies of placenta and amniotic fluid as well as umbilical cord.
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:8] [Pages No:205 - 212]
Keywords: Skeletal dysplasias,Prenatal diagnosis,Ultrasonography,3D ultrasound,3D computed tomography,Fetal MRI
DOI: 10.5005/jp-journals-10009-1197 | Open Access | How to cite |
Abstract
The word dysplasia originates from the ancient Greek words dys (anomalous) and plasia (formation). Skeletal dysplasia (SD) is a heterogeneous group of congenital anomalies characterized by abnormalities in the development of bone and cartilage tissues. These diseases may present either in the form of isolated findings or a phenotypic manifestation of a chromosomal aberration or a genetic disorder. Prenatal diagnosis is mainly on the ultrasonographic appearance, which is usually achieved during the second trimester of pregnancy. Two-dimensional ultrasonography may detect the majority of SD, however, difficulties in the diagnosis as well as the differential diagnosis are frequently arising. In such cases, further evaluation is needed by the use of additional imaging modalities or by invasive procedures, in order to detect an underlying chromosomal abnormality or a single gene disorder. Accurate diagnosis is crucial in order to establish successful genetic counseling as well as appropriate case management. This approach includes the use of three-dimensional ultrasonography and three-dimensional computed tomography; whereas fetal magnetic resonance imaging is less important. These new imaging modalities have an important role in the prenatal multidisciplinary approach of the diagnosis of SD. Despite the indisputable progress that has been achieved during the last few years, in some cases, the antenatal detection of SD delays and is feasible only at the late second or even third trimester. Thus, important ethical and medical issues arise in the antenatal management and counseling of these pregnancies, particularly in the case of lethal SD.
Advances in Ultrasonic Assessment of Acardiac Twin
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:6] [Pages No:213 - 218]
Keywords: Acardiac,Pump twin,TRAP,Monochorionic
DOI: 10.5005/jp-journals-10009-1198 | Open Access | How to cite |
Abstract
The development of an acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin). The final diagnosis for a twin pregnancy with an acardiac twin may be established after the 9th week, when the cephalic extremity and limbs can be precisely determined. Direct signs that lead to the diagnosis of an acardiac twin include the absence of cardiac and fetal movements, difficult visualization of the trunk and cephalic poles, thickening of subcutaneous tissue and the presence of umbilical artery reverse flow towards the acardiac fetus mass. The pump fetus may demonstrate hydramnios, cardiomegaly and heart failure. Once an acardiac anomaly is diagnosed, both the acardiac and pump twins should be assessed to classify the pregnancy according to prognostic factors based on the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. Assessing the extent of heart damage in the pump fetus is a key step in pregnancy management. There are two available options, either conservative or interventional, for the management of these pregnancies. Serial ultrasound surveillance is important for detecting any worsening of the condition, which may suggest the need for interventions to optimize the pump-twin's chance for survival. We performed a retrospective analysis of three cases of monochorionic twin pregnancies diagnosed with a twin reversed arterial perfusion (TRAP) sequence during the first and second trimesters. We compared our data with those offered by a review of the literature.
Multiple Pregnancy under Ultrasound Umbrella
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:12] [Pages No:219 - 230]
Keywords: Multiple pregnancy,Ultrasonography,Multiple pregnancy-specific complications,Intrauterine interventions
DOI: 10.5005/jp-journals-10009-1199 | Open Access | How to cite |
Abstract
Multiple pregnancy care based only on knowledge of fetal number does not satisfy clinical practice any more. Appropriate clinical use of data obtained via skilled and timely ultrasound has been proven to be of great value for reduction of typical complication rate in multiple pregnancy for both fetus and mother. Ultrasonography plays a key role when intrauterine interventions during pregnancy are required. It can be successfully used for both precise prenatal diagnosis of numerous chromosomal and congenital diseases and antenatal treatment of multiple pregnancy-specific complications, so medical professionals should be well-trained and experienced. And it is impossible without everyday clinical work, gaining individual knowledge and skills and being informed on developments and achievements in the best world recognized perinatal centers.
Ultrasound vs MRI in Diagnosis of Fetal and Maternal Complications
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:12] [Pages No:231 - 242]
Keywords: Ultrasound,MRI,Fetal imaging,Prenatal diagnosis
DOI: 10.5005/jp-journals-10009-1200 | Open Access | How to cite |
Abstract
Ultrasound is the screening modality of choice for the fetal imaging. However, there are circumstances in which an alternative imaging technique is needed for additional information regarding fetal anatomy and pathology as well as different maternal conditions. Magnetic resonance imaging (MRI) is being increasingly used as correlative imaging modality in pregnancy because it uses no ionizing radiation, provides excellent soft-tissue contrast, and has multiple planes for reconstruction and large field of view, allowing better depiction of anatomy in fetuses with large or complex anomalies. In this review, we attempted to identify strengths and weaknesses of each modality both from the literature and our own working experience, and to propose to some practical recommendations on when to use which imaging modality. Both ultrasonography and MRI are operator-dependant and neither technique obviates the need for thorough knowledge of normal and abnormal anatomy. In early pregnancy, and where repeated assessment is needed, ultrasound has the obvious advantage. In circumstances where ultrasound examination is difficult, as in the obese patient or severe oligohydramnion, better images might be obtained by MRI examination. MRI might also identify early fetal ischemic lesions after an insult, such as maternal trauma or death of a monochorionic co-twin. From the published literature, it would appear that MRI may provide additional diagnostic information to that given by ultrasound in 25 to 55% of cases, which in turn may have influence on parental counseling and/or management of affected pregnancies. Individual circumstances and expertise influence the accuracy of both modalities. Ultrasound and MRI should be performed to the highest possible standard, and the final diagnosis should be made in a multidisciplinary setting.
Volume Ultrasound in Uterine and Tubal Evaluation
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:14] [Pages No:243 - 256]
Keywords: 3D ultrasound,Sonohysterography,Endometrium,Leiomyoma,Müllerian anomalies,Tube
DOI: 10.5005/jp-journals-10009-1201 | Open Access | How to cite |
Abstract
After the development of the new technologies and rendering modes, it became possible to acquire valuable diagnostic images of the female genital organs. There appear to be few differences in the diagnostic accuracy of standard 2D
From Fetal Imaging to Pediatric Gynecology Imaging in a 22-Year Span
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:10] [Pages No:257 - 266]
Keywords: Fetal growth curve,IUGR,2D,3D and Doppler ultrasound,Pediatric gynecology,Transabdominal sonography (TAS),Transvaginal sonography (TVS),Transrectal sonography (TRS),Transperineal sonography (TPS),Breast ultrasound
DOI: 10.5005/jp-journals-10009-1202 | Open Access | How to cite |
Abstract
A review of the ultrasound experiences of the author since 1989 up to the present. Ultrasound pictures taken for fetal and pediatric gynecology imaging are presented. The impact of ultrasound examination is the improvement of perinatal outcome and diagnosis and management of gynecological problems of children, thus preserving their future fertility.
Echographic Evidence of Follicle Development and Maturation
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:6] [Pages No:267 - 272]
Keywords: Ultrasound,Ovarian monitoring,Follicle growth,Natural cycle,Controlled ovarian hyperstimulation,Perifollicular vascularization Monitoring
DOI: 10.5005/jp-journals-10009-1203 | Open Access | How to cite |
Abstract
Monitoring of individual follicles during the menstrual cycle demonstrates in a non-invasive way the changes in their number and position during the early and the late follicular phase and the luteal phase. The differences in relations between the follicles near the dominant follicle can be demonstrated with the same technique using 3D reconstruction of the ovary. Recognition of the follicle growth pattern has a prognostic value for the outcome of assisted reproduction methods. Follicular diameter and changes in growth patterns are more important than follicular wall thickness as parameters having an impact on clinical success. An increased perifollicular blood flow can be measured in the perifollicular period using color and pulsed Doppler. Automated estimation of blood volume around the ovarian follicles brought a new concept to this area. Results confirm the observation that vascularity around the follicle is intense in the periovulatory period. From our results we can hypothesize that those follicles containing oocytes able to produce pregnancy have a prominent and more uniform perifollicular vascular network .
Rational Use of TVS/Color and 3D in Evaluating Subfertile Women
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:15] [Pages No:273 - 287]
Keywords: Infertility,Transvaginal ultrasound,Color Doppler,Three-dimensional ultrasound,Power Doppler angiography
DOI: 10.5005/jp-journals-10009-1204 | Open Access | How to cite |
Abstract
Infertility is defined as the failure to conceive a desired pregnancy after 12 months of unprotected intercourse and affects approximately 10% of married couples. With recent technological development and proper use of medically assisted reproduction techniques, one half of these couples will become pregnant. More than any other new method, ultrasound has made significant improvements in the modern management of female infertility. Transvaginal sonography provides the reproductive endocrinologists with a tool that cannot only evaluate normal and stimulated cycles but also assist in follicle aspiration and subsequent transfer of the embryo. The addition of color Doppler capabilities to transvaginal probes permits visualization of small intraovarian and endometrial vessels, allowing depiction of normal and abnormal physiologic changes in the ovary and uterus. This article reviews on the assessment of ovarian, uterine and tubal causes of infertility and on the current and future role of color Doppler and three-dimensional ultrasound in the field of reproductive endocrinology.
Obstetric Ultrasounds in Africa: Is it Necessary to Promote their Appropriate Use?
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:8] [Pages No:289 - 296]
Keywords: Obstetric ultrasonography,Africa,Developing countries,Cooperation,Commodification
DOI: 10.5005/jp-journals-10009-1205 | Open Access | How to cite |
Abstract
This paper reviews the situation of obstetric ultrasound scans in Africa (extent of use, sonographer training, indications and results, etc.). Special emphasis is given to the advisability of legally regulating their use, the need for improved training among today's sonographers and the potential dangers that the incorrect and indiscriminate use of ultrasounds can involve. The paper condemns the commodification of the technique and reviews the current status of scientific production.
Ultrasound Education and Research in Developing Countries
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:6] [Pages No:297 - 302]
Keywords: Ultrasound,Education,Research,Developing countries
DOI: 10.5005/jp-journals-10009-1206 | Open Access | How to cite |
Abstract
This experience based study was done to share the experience with the readers of this article as well as with the leaders of the modality in these countries and throughout the world of ultrasound. The need of adequate education and training in ultrasound exists in both industrialized and developing countries. In this study educational and training standards in twenty countries is discussed and it is recommended to start proper programs with global guidelines.
Accuracy of Ultrasound Measurements by Novices: Pixels or Voxels
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:7] [Pages No:303 - 309]
Keywords: Novice,3D ultrasound,2D ultrasound
DOI: 10.5005/jp-journals-10009-1207 | Open Access | How to cite |
Abstract
During the last two decades three-dimensional (3D) ultrasound has become increasingly popular around the world. There have been a great number of research papers studying its feasibility as well as reliability and accuracy. Compared to two-dimensional (2D), 3D ultrasound produces better visualization with minimal probe manipulation. The sonographer performing 2D ultrasound has to mentally assemble crosssectional images of a structure and/or object into a 3D image. In cases with uncertain anatomic orientation less experienced examiners may experience difficulties in envisioning three dimensions of the visualized structure, lesion or organ. Patients and parents are often faced with similar problems. A number of studies have shown that novice operators can efficiently store and interpret the volume data by 3D ultrasound, which may have many positive implications in the practice.
Transvaginal Ultrasonography in Female Infertility Evaluation
[Year:2011] [Month:July-September] [Volume:5] [Number:3] [Pages:6] [Pages No:311 - 316]
Keywords: Endometrial thickness,Endometrioma,Hydrosalpinx,Endometrial polyp,Adenomyosis,Leiomyoma
DOI: 10.5005/jp-journals-10009-1208 | Open Access | How to cite |
Abstract
Ultrasound has become essential in the diagnosis and management of the infertile female. Transvaginal ultrasonography provides a detailed examination of the uterus and ovaries. Evaluation of the infertile female has become increasingly more detailed in recent years because of technologic advancements as vaginal ultrasonography is the first step in assessment of pelvic infertile female.