Fetal Imaging

Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.     

Labile Self-Esteem, Life Stress, and Depressive Symptoms: Prospective Data Testing A Model of Vulnerability

Recent theory and research suggests that labile self-esteem (SE) is an important dimension of vulnerability to depression (Butler, Hokanson, & Flynn, 1994; Roberts & Monroe, 1992, 1994, in press). In the present study, participants completed seven daily ratings of SE from which we derived a measure of lability. The interaction between labile SE and life stress predicted increases in depressive symptoms across a two-month prospective interval, particularly in participants who were initially low in depression and who had more severe worst lifetime episodes of depressive symptomatology. Interactions between life stress and labile SE were stronger for life stress measures that were based on the subjective appraisal of stress than for those that were based on raw life event counts. In contrast to predictions, depletions in self-esteem failed to mediate the synergistic effects of labile SE and life stress.     

The Association Between Perceived Stress and Quality of Life in University Students: The Parallel Mediating Role of Depressive Symptoms and Health-Promoting Behaviors

Purpose

This study examined whether depressive symptoms and health-promoting lifestyle behaviors mediate the association between perceived stress and quality of life (QoL) in university students.

Relationships Among Prenatal Maternal Attachment, Presence of Postnatal Depressive Symptoms, and Maternal Role Attainment

purpose . To examine the relationships among a woman's attachment to her fetus, the presence of postpartum depressive symptoms, and subsequent perceptions of maternal role attainment three months after birth
design . A longitudinal, panel design
setting . Hospital-sponsored childbirth education classes
participants . Primiparous women (N = 136) at 24–40 weeks of pregnancy and 9–14 weeks after the birth
main outcome measures . Perceived Competence Scale, Myself as Mother Scale, and My Baby Scale
results . Prenatal maternal attachment was positively related to maternal role attainment but not to postpartum depressive symptoms. Postpartum depression was negatively related to maternal role attainment.
conclusions . These findings enhance maternal identity theory and provide a means to evaluate the transition to motherhood.     

Methodology for Using 3‐Dimensional Sonography to Measure Fetal Adrenal Gland Volumes in Pregnant Women With and Without Early Life Stress

Fetal adrenal gland volumes on 3‐dimensional sonography have been studied as potential predictors of preterm birth. However, no consistent methodology has been published. This article describes the methodology used in a study that is evaluating the effects of maternal early life stress on fetal adrenal growth to allow other researchers to compare methodologies across studies. Fetal volumetric data were obtained in 36 women at 20 to 22 and 28 to 30 weeks' gestation. Two independent examiners measured multiple images of a single fetal adrenal gland from each sonogram. Intra‐ and inter‐rater consistency was examined. In addition, fetal adrenal volumes between male and female fetuses were reported. The intra‐ and inter‐rater reliability was satisfactory when the mean of 3 measurements from each rater was used. At 20 weeks' gestation, male fetuses had larger average adjusted adrenal volumes than female fetuses (mean, 0.897 versus 0.638; P = .004). At 28 weeks' gestation, the fetal weight was more influential in determining values for adjusted fetal adrenal volume (0.672 for male fetuses versus 0.526 for female fetuses; P = .034). This article presents a methodology for assessing fetal adrenal volume using 3‐dimensional sonography that can be used by other researchers to provide more consistency across studies.     

Prenatal Sonographic Diagnosis of Premature Constriction of the Fetal Ductus Arteriosus After Maternal Self‐Medication With Benzydamine Hydrochloride

We report 3 cases of prenatal diagnosis of premature constriction of the ductus arteriosus after maternal benzydamine hydrochloride therapy (3‐mg lozenges) in third‐trimester pregnancies. In each case, fetal echocardiography revealed a dilated, hypocontractile right ventricle with severe tricuspid regurgitation and constriction of the ductus arteriosus. Although the effect of indomethacin and other nonsteroidal anti‐inflammatory drugs on prenatal ductal constriction is well known, readily available over‐the‐counter nonsteroidal anti‐inflammatory drugs such as benzydamine can have an equally deleterious effect and are best avoided in the third trimester of pregnancy.     

Two‐Dimensional Speckle Tracking of the Fetal Heart

Various approaches to 2‐dimensional speckle tracking have been used to evaluate left ventricular function and deformation in the fetus, child, and adult. In 2015, because of differences in imaging devices and analytical programs, the cardiology community published a consensus document proposing standards for pediatric/adult deformation imaging using 2‐dimensional speckle tracking. The understanding and application of deformation imaging in the fetus have been limited by a lack of uniform software, terminology, techniques, and display. This article provides a practical, step‐by‐step approach for deformation analysis of the fetal heart using offline software that is independent of specific ultrasound vendors.