Ultrasound prenatal diagnosis of fetus in fetu.

A case of fetus in fetu was diagnosed prenatally using ultrasound. The differential diagnosis between a fetus in fetu and a highly differentiated teratoma is discussed. The importance of prenatal diagnosis of fetus in fetu and the effect on subsequent management are described.     

Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial.

OBJECTIVE: False positive diagnosis of preterm labor is common. As a consequence, medications including corticosteroids to promote fetal lung maturity and tocolysis are prescribed unnecessarily. We tested the hypothesis that management of threatened preterm labor based on measurement of cervical length by ultrasonography can reduce the number of women who receive inappropriate treatment. METHODS: Forty-one women with threatened preterm labor for whom a clinical decision was made to prescribe antenatal corticosteroids and tocolysis were randomized to have their cervical length measured by transvaginal ultrasound (n=21) or to receive therapy as planned (n=20). Fourteen women in the ultrasound group had a cervix longer than 15 mm and the therapy was withheld, while the other seven with a short cervix were managed in the same way as the control group. RESULTS: Three women (14%) in the ultrasound group were treated inappropriately with antenatal corticosteroids because they remained undelivered for more than a week. This compared favorably with the control group where 18 out of 20 (90%) received corticosteroids unnecessarily (relative risk (RR) 0.16; 95% confidence interval (CI), 0.05-0.39). Tocolysis was given to only seven women (33.3%) in the ultrasound group compared with 20 (100%) in the control group (RR 0.3; 95% CI, 0.15-0.54). There were no babies in either group who were born prematurely without being given a full course of antenatal corticosteroid therapy. CONCLUSION: Women with threatened preterm labor and cervical length more than 15 mm should not receive tocolysis. The issue of the safety of withholding corticosteroid therapy in this clinical scenario warrants further study.     

Relapse of maternal thyrotoxicosis presenting as a second-trimester fetal goiter.

A large fetal goiter was detected at 22 weeks of gestation during an antenatal ultrasound scan of a woman with a previous history of Graves' disease treated by partial thyroidectomy. This unsuspected finding initiated maternal investigations and treatment. In untreated cases poor fetal outcome is common and unfortunately fetal thyrotoxicosis/thyroid enlargement frequently remains unrecognized in the first pregnancy. We report the case and its management and discuss the literature emphasizing the importance of screening for antibodies in the 'at-risk' women and the increasing importance of ultrasound in the evaluation and follow-up of these patients.Reports of thyrotoxic fetal goiters are extremely rare and, to our knowledge, there have been no previous reports of this in the second trimester.     

HDlive imaging of fetal enteric duplication cyst

Enteric duplication cysts are rare congenital anomalies, but their antenatal diagnosis is becoming more common because of advances in ultrasonography. With the latest state-of-the-art technology, HDlive facilitates a more realistic anatomical visualization of different fetal organ structures, making diagnosis more precise. We present a case of antenatal HDlive imaging of an enteric duplication cyst. A 26-year-old pregnant Japanese woman was referred to our ultrasound clinic because of a fetal intra-abdominal cyst at 27 weeks of gestation. Two-dimensional (2D) ultrasound revealed a sonolucent, ellipsoid structure in the subhepatic area. Magnetic resonance imaging yielded the same findings. However, irregular internal echoes appeared at 33 weeks of gestation. There was no vascularity on color Doppler. HDlive clearly depicted a more realistic image of the circular mass, which was thick walled, with a large amount of debris inside, and showed no communication with adjacent structures. Careful monitoring was conducted for these unusual findings. A day after delivery, an emergency operation was performed because the infant had sudden signs and symptoms of obstruction. Intra-operative findings were ileus and a necrotic ileal duplication cyst confirmed by histopathologic studies. Complications of enteric duplication cyst can arise at any time of life, and so thorough monitoring may be recommended. The findings of irregular internal echoes and a large amount of debris inside the cyst are relatively characteristic features of a complicated cyst. HDlive gives us additional information on the actual appearance of a complicated cyst that may be difficult to obtain using conventional 2D sonography alone. HDlive can be very useful in the antenatal surveillance of enteric duplication cysts.     

Ultrasound-enhanced thrombolysis using Definity as a cavitation nucleation agent

Ultrasound has been shown previously to act synergistically with a thrombolytic agent, such as recombinant tissue plasminogen activator (rt-PA) to accelerate thrombolysis. In this in vitro study, a commercial contrast agent, Definity((R)), was used to promote and sustain the nucleation of cavitation during pulsed ultrasound exposure at 120 kHz. Ultraharmonic signals, broadband emissions and harmonics of the fundamental were measured acoustically by using a focused hydrophone as a passive cavitation detector and used to quantify the level of cavitation activity. Human whole blood clots suspended in human plasma were exposed to a combination of rt-PA, Definity((R)) and ultrasound at a range of ultrasound peak-to-peak pressure amplitudes, which were selected to expose clots to various degrees of cavitation activity. Thrombolytic efficacy was determined by measuring clot mass loss before and after the treatment and correlated with the degree of cavitation activity. The penetration depth of rt-PA and plasminogen was also evaluated in the presence of cavitating microbubbles using a dual-antibody fluorescence imaging technique. The largest mass loss (26.2%) was observed for clots treated with 120-kHz ultrasound (0.32-MPa peak-to-peak pressure amplitude), rt-PA and stable cavitation nucleated by Definity((R)). A significant correlation was observed between mass loss and ultraharmonic signals (r = 0.85, p < 0.0001, n = 24). The largest mean penetration depth of rt-PA (222 mum) and plasminogen (241 mum) was observed in the presence of stable cavitation activity. Stable cavitation activity plays an important role in enhancement of thrombolysis and can be monitored to evaluate the efficacy of thrombolytic treatment. (E-mail: Christy.Holland@uc.edu).     

Hemiatrophy of brain: antenatal ultrasonography and MRI/postnatal MRI diagnosis with the introduction of “shifted falx sign”

Dyke–Davidoff–Masson syndrome (DDMS) is an uncommon congenital/pediatric disorder diagnosed only with the help of imaging. Clinical features associated with it are hemiparesis, seizures, facial asymmetry, and mental retardation. We here present a case of DDMS diagnosed antenatally at 29 weeks gestational age during routine antenatal ultrasound examination. The patient was further evaluated and followed using both ultrasound and magnetic resonance imaging during antenatal and postnatal periods. The infant had unilateral hemiatrophy with the absence of anterior and middle cerebral arteries. We hereby also want to coin the term “shifted falx sign” as a diagnostic indicator for DDMS for the first time. To our knowledge, this is the earliest antenatally sonologically diagnosed case of the said pathology.     

Two-dimensional vs. two- plus four-dimensional ultrasound in pregnancy and the effect on maternal emotional status: a randomized study.

OBJECTIVE: To assess whether the addition of four-dimensional (4D) ultrasound to a conventional two-dimensional (2D) scan in the second/third trimester of pregnancy facilitates maternal recognition of specific fetal structures and movements and causes an emotional impact, as subjectively perceived by the woman. METHODS: Fifty-two women were randomly assigned to 2D ultrasound only (Group 1), while 48 women underwent 2D plus 4D ultrasound (Group 2). All the women completed two questionnaires. One questionnaire listed the fetal structures and movements that the women had recognized during the 2D scan or, for those women who also underwent a 4D scan, during the combination of the two; the other questionnaire required the women to score on an analog scale whether they had seen all the fetal parts and movements that they wished to see, whether they were satisfied with the scan, and if the scan had changed for the better their perception of the fetus. A subgroup of 46 women completed the Maternal Antenatal Attachment Scale (MAAS) designed to measure antenatal emotional attachment. RESULTS: Similar percentages of women in the two groups visualized fetal structures and movements, but facial expressions and hand-to-mouth movements were twice as likely to be seen with 4D ultrasound, although this difference did not reach statistical significance. The percentage of women who reported that they had seen all the fetal parts and movements that they wished to see, and of those who were satisfied overall with the scan, were similar in the two groups. There was no difference in the percentage of women who felt that the scan had changed for the better their perception of the fetus. Although the MAAS scores were similar in the two groups, there were more women with positive quality, intensity and global attachment among those who had undergone a 4D scan. Women who had seen all the fetal parts and movements they wished to see (whether with 2D or 2D plus 4D) answered more frequently that the scan had changed for the better their perception of the fetus. CONCLUSION: This randomized study indicates that the addition of 4D ultrasound does not change significantly the perception that women have of their baby nor their antenatal emotional attachment compared with conventional 2D ultrasound.     

Midwives' attitudes to and knowledge about a newly introduced foetal screening method

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.     

脊髓纵裂产前超声诊断并文献回顾

目的探讨脊髓纵裂的产前超声图像特征。方法对1例怀疑椎管内肿瘤的胎儿行系统产前超声检查,超声诊断为脊髓纵裂,总结胎儿脊髓纵裂产前超声诊断特点,与引产后胎儿的高频超声、X线、MRI及病理解剖进行对比研究,并对脊髓纵裂产前诊断相关文献回顾分析。结果本例脊髓纵裂发生于胸6～9水平,椎管内可见圆形高回声占位病变,脊髓受压分成两半,于远端汇合,相应的椎弓骨化中心明显增宽。脐血染色体核型正常。本例终止妊娠后,标本行产后超声、X线照片、MRI检查及病理解剖,证实产前超声诊断。结论脊髓纵裂有特征性超声表现,产前超声可作出诊断。     

Mid-trimester fetal subdural hemorrhage: prenatal diagnosis.

A routine antenatal ultrasound examination at 20 weeks' gestation revealed a space-occupying lesion in the fetal right cerebral hemisphere. The borders of the mass were indistinct and there was no midline shift. A small collection of echogenic bowel was identified at the right iliac fossa. In an attempt to explain both findings a provisional diagnosis of a fetal blood dyscrasia was made. Fetal cranial magnetic resonance imaging 24 h later confirmed the diagnosis of a subdural hemorrhage. Subsequent fetal blood sampling confirmed severe fetal thrombocytopenia. To our knowledge this is the first report of the antenatal diagnosis of spontaneous mid-trimester fetal subdural hemorrhage.     

高强度聚焦超声治疗子宫肌瘤二维超声图像与坏死程度比较

目的 总结分析超声在HIFU治疗子宫肌瘤术中监控和治疗后的声像图特点,使超声在术中监控及评价疗效方面更加客观、准确.方法 对超声图像进行数字化处理,并把超声图像与MRI图像进行比较分析,比较不同坏死程度的肌瘤间超声图像的差异.结果 术中肌瘤灰度值增加明显表明治疗有效,而以团块状灰度增加更具特征性;完全坏死的肌瘤术后灰度值增加明显.结论 在术中,超声可以实时显示肌瘤的变化,并可通过这些改变反馈调整和控制辐照剂量.术后,超声也可以比较准确地评价疗效.     

胎儿肾上腺区肿物的超声表现及结局

目的探讨超声对胎儿肾上腺区肿物的诊断及临床处理意义。 方法对2014年1月至2016年6月在首都医科大学附属北京妇产医院进行超声检查并诊断为肾上腺区肿物的17例胎儿产前超声表现、产后随访结果及其临床结局进行分析。 结果17例胎儿肾上腺区肿物中左侧8例,右侧7例,双侧2例,共19个肿物;初次检查肿物长径1.2~6.5 cm,平均（2.8±1.4）cm;初次检查时4个肿物内部回声为囊性（单房2个,多房2个）,11个肿物为囊实性,4个肿物为实性（高回声2个,低回声2个）;7个肿物内部有点状或条状血流信号。3例胎儿产前复查超声,2例肿物体积稍增大,1例明显增大,其中2例内部回声无明显变化,1例内部回声从单房囊性变为囊实性。17例中4例孕妇选择终止妊娠;继续妊娠的13例中8例在足月产前超声或出生后超声检查显示肿物消失,临床考虑肾上腺出血;余5例中3例在出生后接受手术治疗并证实为肾上腺神经母细胞瘤,2例临床考虑肾上腺神经母细胞瘤行动态观察,随诊过程中肿物逐渐变小或消失。 结论肾上腺出血及肾上腺神经母细胞瘤超声表现有一定特点,产前超声检查对于明确诊断和肿物的临床处理均有较重要意义。     

Antenatal hydronephrosis: trends and management

Hydronephrosis is the dilatation of the collecting system of the kidney. Prenatal ultrasound has significantly increased the detection rate for fetal abnormalities during the past 20 years. The wide range of management and treatment options for antenatal hydronephrosis often leave health care providers and families with questions about the appropriateness of referral to a pediatric urologist and the need for postnatal screening. Pre and postnatal management, radiologic findings, and treatment options are reviewed and three case scenarios presented.     

早产儿生后感染所致严重脑损伤

目的探讨早产儿严重感染后出现脑实质广泛软化的临床特点及影像学特征。方法对我院2例早产男婴严重感染后发生脑实质广泛软化的临床资料进行回顾性分析。结果 2例均在生后3周左右发病,表现为反应差、呼吸暂停、超敏C反应蛋白增高、严重肺炎、痰培养多重耐药细菌生长、脑脊液轻微改变等,予呼吸机和抗菌素治疗后病情稳定,临床症状逐渐好转,但影像学检查显示患儿出现广泛脑软化。其母在怀孕期间均无感染迹象及胎膜早破病史,提示患儿脑软化与产后感染有关,而非产前感染所致。结论本研究提示临床不仅需研究产前感染与新生儿脑软化的相互关系,还应增加对早产儿产后感染也可诱发脑软化的认识,常规行头颅超声检查,以早期诊断并进行有效的治疗。     

Two-dimensional ultrasound is accurate in the diagnosis of fetal craniofacial malformation.

OBJECTIVE: To assess the accuracy of antenatal ultrasound in the diagnosis of craniofacial malformations and to compare two-dimensional with three-dimensional ultrasound. METHODS: This was a retrospective study in which the archives of our ultrasound laboratory were searched for cases with an ultrasound diagnosis of craniofacial malformation in the period 1986-2001. No attempt was made to look for false-negative diagnoses. RESULTS: Sixty cases with an antenatal diagnosis of a craniofacial malformation were found: 37 with cleft lip/palate; 17 with heterogeneous dysmorphisms (including mostly micrognathia and craniosynostosis) and 6 with miscellaneous craniofacial malformations. Associated anomalies were present in 48/60 (80%) cases, and holoprosencephaly (25 cases) was the most frequent of these. In 43 (72%) cases the diagnosis was made before 24 weeks' gestation. Postnatal follow-up was available for 43 cases and there was always complete correlation between antenatal and postnatal diagnoses. Cleft lip/palate was always accurately differentiated from cleft lip. Three-dimensional ultrasound was performed in 12 cases and was successful in 11. However, it did not provide further diagnostic information with regard to the two-dimensional scan. DISCUSSION: Current two-dimensional ultrasound in expert hands allows an accurate diagnosis of craniofacial abnormalities from early gestation. In our hands, three-dimensional ultrasound did not add any valuable diagnostic information. Three-dimensional ultrasound may facilitate the understanding of the lesion by the parents and facilitate communication with the plastic surgeons. However, these potential benefits need to be carefully weighed against the costs of the ultrasound instrumentation, increased examination time and training of personnel.     

Perinatal diagnosis and management of oropharyngeal fetus in fetu: A case report

Fetus in fetu is an extremely rare congenital anomaly. We describe the perinatal diagnosis and management of a fetus with oropharyngeal and cervical fetus in fetu. High‐resolution ultrasonography with 3‐dimensional rendering can identify increased risks of airway obstruction in utero. Early identification allows a multidisciplinary team to be assembled for a scheduled ex utero intrapartum treatment procedure.     

Outcome of fetal renal pelvic dilatation diagnosed during the third trimester.

OBJECTIVES: The aim of this study was to evaluate renal function and the need for postnatal treatment--antibiotic therapy and/or surgery--in relation to the grade of fetal renal pelvic dilatation (RPD) found on third-trimester ultrasound examination. METHODS: The retrospective study included 78 children, born between 1995 and 2000, with 115 dilated fetal renal pelvic units. The children were allocated to three groups based on pelvic anteroposterior diameter (APD) detected on third-trimester ultrasound: APDs of 7-9.9 mm, 10-14.9 mm and > or = 15 mm were classified as mild dilatation, moderate hydronephrosis and severe hydronephrosis, respectively. Renal function was assessed by scintigraphy. RESULTS: None of the 20 children with mild dilatation experienced a urinary tract infection (UTI) or underwent surgery; two had associated renal or urinary tract abnormalities. In contrast, five out of 22 (23%) children with moderate hydronephrosis and 23 out of 36 (64%) with severe hydronephrosis had either a UTI or required surgery (P < 0.001); associated abnormalities were also more common (6 out of 22 and 15 out of 36, respectively). There was no significant correlation between the grade of antenatal RPD and postnatal ipsilateral renal function. CONCLUSIONS: The need for postnatal treatment increased significantly with the grade of antenatal RPD. Children with antenatal mild dilatation were discharged early from follow-up whereas those with moderate and severe fetal hydronephrosis needed close follow-up by a multidisciplinary team.     

Acute bowel perforation in a fetus with gastroschisis.

Gastroschisis is a congenital anomaly with a reported incidence of 1 in 10,000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established. Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate Cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post-partum findings, including bowel pathology, confirmed the antenatal diagnosis. Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome.     

腹膜后内寄生胎产前和新生儿期的临床与超声影像学特征

目的探讨腹膜后内寄生胎产前和新生儿期的临床及超声影像特征。 方法收集湖北省妇幼保健院2016年1月至2020年1月产前超声检查发现宿主胎儿腹腔内肿块、于新生儿期手术并经病理证实为腹膜后内寄生胎8例。总结产前和新生儿期的临床资料及超声影像资料，并将超声特征与手术、病理结果进行对照分析。 结果8例腹膜后内寄生胎的超声影像特征为：囊实性肿块；肿块边界清楚，囊壁薄；实质性成分（寄生胎）随孕龄增长而增大，并渐具胎儿雏形，超声易识别发育不良的脊柱轴、颅骨环、长骨、肢芽、增厚的皮肤等结构，实质性成分周围包绕囊液；寄生胎有血管蒂与宿主血管分支相连；肿块多数位于腹腔中轴线稍偏左或偏右、脊柱和腹主动脉前方、双肾之间。临床结局为：8例均于出生后5~27 d手术，其中1例合并回肠美克尔憩室，1例合并成熟囊性畸胎瘤；其中4例行开腹手术，1例腹腔镜转开腹手术，3例行腹腔镜手术。8例术后均恢复良好，随访至今均未复发。病理结果为：8例腹膜后内寄生胎中单寄生胎6例，双寄生胎2例，共10个寄生胎。与病理结果对照，超声检出率最高的是骨性组织（9/9）、颅骨环（2/2）；其次是长骨（6/7）、脊柱轴（6/8）、肢芽（6/9）、血管蒂（6/10）和皮肤（4/10）。 结论腹膜后内寄生胎超声影像有特征性表现，并与临床手术及病理表现相对应。系统规范的超声检查可尽早正确诊断内寄生胎，对于宿主胎儿出生后选择合适的诊疗方法和治疗时机具有十分重要的意义。