Pooh RK. ‘See-through Fashion’ in Prenatal Diagnostic Imaging. Donald School J Ultrasound Obstet Gynecol 2015;9(2):111.

To assess what clinical and ultrasound features could be most helpful for discriminating benign from malignant unilocular cysts with solid components in premenopausal women with no signs of ascites or carcinomatosis.

Retrospective study comprising 91 women with preoperative diagnosis of unilocular-solid cyst that underwent surgical removal. The following variables were assessed: age, complaints at presentation, bilaterality, mean size of the lesion, number of papillary projections, size of solid component, surface of solid component (smooth or irregular), amount of color within solid component (no flow, minimal flow, moderate flow, abundant flow). Definitive histopathological diagnosis was used as gold standard. Multivariate logistic regression analysis was performed to identify which variables were independent predictors of malignancy and their odds ratios (OR).

Malignant lesions had significantly larger tumor size, more number of solid components, larger size of solid component, more frequency of irregular surface in the solid component and more frequent moderate or abundant vascularization within the solid component. Logistic regression analysis identified amount of color (OR: 48.7), solid component's surface (OR: 29.1) and mean size of the lesion (OR: 1.58) as independent predictors for malignancy.

Tumor size, irregular surface and the presence of moderate or abundant color score within the solid component are the features more frequently associated to malignancy in unilocular-solid adnexal cysts in premenopausal women.

Juez L, Peces A, Corral TMA, Orozco R, Utrilla-Layna J, Caparros M, Alcazar JL. Ultrasound Features for Determining the Risk of Malignancy in Unilocular- Solid Adnexal Masses in Premenopausal Women without Ascites and/or Carcinomatosis. Donald School J Ultrasound Obstet Gynecol 2015;9(2):112-117.

Ectopic pregnancy case fatalities have decreased dramatically, although incidence has remained steady over years. Advancement in early diagnosis methods and introduction of methotrexate (MTX) in the management has led to such improvement. Different protocols, such as single, two dose and multiple doses of MTX has been indorsed by the American congress of obstetrics and gynecology. Here at Women's Hospital in Qatar we use single dose protocol. However, there no previous report on the outcome of MTX in term success rate in Qatar.

A retrospective study on patients diagnosed with tubal ectopic pregnancy between Jan 2008 and Dec 2010 were conducted. Institutional review board of Hamad Medical Corporation, Qatar, approved this study. Statistical analysis were done using SPSS Inc. Ver 20, Chicago, IL.

Two hundred and forty-eight file met the study inclusion and exclusion criteria, but only 196 completed their followup until beta-human chorionic gonadotropin (â-hCG) less than 15 IU/L. Methotrexate prescribing has increased three times over the study period. The success rate for MTX was 89% and it was positively correlated with lower initial β-hCG levels. However, six out six patients with in β-hCG levels more than 10,000 IU/L were successfully treated with MTX.

Methotrexate is effective method of treatment in stable patients. Further studies are required to investigate role of MTX in patients with high β-hCG levels (> 10,000 IU/L).

Gasim M, Diai M, Taha M, Alsaadi M, Chandra P, Mohamed A, Bayo AI, Ahmed B. Outcome of Methotrexate Management in Tubal Ectopic Pregnancy: A Retrospective Study in Women's Hospital in Qatar. Donald School J Ultrasound Obstet Gynecol 2015;9(2):118-122.

Bonilla-Musoles F, Martin N, Esquembre MP, Caballero O, Castillo JC, Bonilla F Jr, Raga F, Machado L. Uterine Malformations: Diagnosis with 3D/4D Ultrasound. Donald School J Ultrasound Obstet Gynecol 2015;9(2):123-148.

Bonilla-Musoles F, Raga F, Bonilla F Jr, Castillo JC, Machado LE, Luna OC. Gynecological Tumor Images using HDlive US. Donald School J Ultrasound Obstet Gynecol 2015;9(2):149-158.

Birth defects are common in human development. Approximately 3% of newborns have a recognizable major anomaly, and at least 5% will ultimately be diagnosed with a congenital defect. Because of improvements in other areas of prenatal care, birth defects are the single most common cause of perinatal mortality in developed countries, accounting 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.

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). Ultrasound 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 Kosovo. There are some different anomalies of almost all systems of the organs of the fetal body, some of them more frequent and some very rare anomalies.

Ultrasound diagnostic is a very useful method for evaluating the fetal health, fetal anomalies, anomalies of placenta and amniotic fluid as well as umbilical cord.

Sylejmani S, Syla B, Shala S. Diagnosis of Congenital Anomalies during Routine Fetal Surveillance. Donald School J Ultrasound Obstet Gynecol 2015; 9(2):159-174.

Kasar P, Andonotopo W, Kupesic Plavsic S. Ultrasound Imaging of Postpartum Hemorrhage. Donald School J Ultrasound Obstet Gynecol 2015;9(2):175-187.

Adenomyosis is a common gynecological disease that is defined as the presence of nonneoplastic ectopic endometrial glands and stroma in the myometrium. These characteristics are associated with reactive overgrowth of the musculature. The aim of this pictorial essay was to delineate the specific sonographic features of adenomyosis as seen with twodimensional (2D) and three-dimensional (3D) ultrasonography.

Evaluation of the adenomyosis is best achieved in daily practice with transvaginal ultrasonography.

The most important features of adenomyosis are anechoic foci, striation, heterogeneous myometrium, and an asymmetrical uterine wall. All of these features were seen in this study by 2D ultrasonography. Three-dimensional ultrasonography allowed visualization of the thickness and disruption of the endometrial-myometrial junction.

Two-dimensional and 3D ultrasonography are valuable tools for diagnosing adenomyosis even in early stages of the disease because they make it possible to evaluate both the myometrium and the endometrial-myometrial junction. The combined information gained from the 2D and 3D ultrasonography examinations not only allows diagnosis of adenomyosis but also pinpoints the current stage of the disease.

Grigore M. Adenomyosis: Pictorial Essay of Two-Dimensional and Three-Dimensional Ultrasonography Findings. Donald School J Ultrasound Obstet Gynecol 2015;9(2):188-192.

Bonilla-Musoles F, Caballero O, Castillo JC, Bonilla F Jr, Raga F. HDlive and Three-Dimensional Imaging in Prenatal Diagnosis of Sirenomelia in the First Trimester: A Case Report and Brief Review of the Literature. Donald School J Ultrasound Obstet Gynecol 2015;9(2):193-196.

This study aimed to assess whether Brazilian doctors demonstrate an interest in participating in ultrasound (US) distance courses.

Focused directly on the theoretical part of the course, and estimating that the doctor already has prior knowledge of operating the machine, a closed questionnaire of 22 multiple choice questions was sent to Brazilian physicians by Internet.

It was found that, among doctors who perform ultrasonography, 98.5% would like to do a training course, either in person or remotely, with 15.1% preferring distance courses. When the question was solely on performing ultrasound distance courses, 79.5% of respondents would like to complete a course administered in this manner.

This research demonstrated that there is great interest in medical ultrasonographic courses conducted remotely. This method could allow a more appropriate distribution of the schools in this area across the country, facilitating access to knowledge and professional development of physicians residing in remote areas.

AMB: Brazilian medical association, CFM: Federal council of medicine, DE: Distance education, CME: Continuing medical education, US: Ultrasound.

Neto RM. Distance Education in Medical Ultrasound in Brazil. Donald School J Ultrasound Obstet Gynecol 2015;9(2):197-202.