Prenatal sonographic features of spondylocostal dysostosis and diaphragmatic hernia in the first trimester.

Spondylocostal dysostosis is a congenital disorder characterized by multiple malformations of the vertebrae and ribs. We describe the sonographic features of an affected fetus at 12 and 14 weeks of gestation. The fetus had thoracic scoliosis, multiple vertebral and rib malformations and a grossly dilated stomach that had herniated into the chest through a left-sided diaphragmatic hernia. The stomach spanned the whole length of the fetal trunk.     

Three-dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy.

OBJECTIVE: To evaluate the fetal behavior pattern in the early second trimester of pregnancy by use of specially developed abdominal dynamic three-dimensional sonography. METHODS: Dynamic three-dimensional sonographic examinations were performed on 11 healthy pregnant women at 14 to 18 weeks of gestation. This imaging system provided continuous three-dimensional sonographic images every 1 to 2 seconds. Fetal movements were recorded continuously for 60 minutes in each fetus. The rate of occurrence of head, mouth, arm, trunk, and leg movements was evaluated. All fetal behavioral patterns were observed during the period studied. RESULTS: The active phase (time with fetal movements) was 59.4%, and the resting phase was 40.6%. The most active fetal behavior pattern was an arm movement, whereas the least was a mouth movement. Moreover, each fetal movement was synchronized and harmonized with other fetal movements (a few movement patterns were found to be generated simultaneously). CONCLUSIONS: Dynamic three-dimensional sonography provides a novel means for evaluation of fetal behavior in the early second trimester of pregnancy. These results suggest that dynamic three-dimensional sonography may be an important modality in future early fetal behavior research and in evaluation of early fetal well-being.     

Sonographic findings of trisomy 18 in the second trimester of pregnancy

OBJECTIVE: The purpose of this study was to examine the sonographic findings in fetuses with trisomy 18 in the second trimester of pregnancy. METHODS: A retrospective review of the cytogenetic laboratory databases at 6 tertiary referral centers identified all cases of trisomy 18. The prenatal sonographic studies in fetuses at 15 to 21 weeks' gestation, done before invasive testing for the karyotype, were reviewed for anatomic and biometric findings. We defined abnormal fetal biometric findings as a biometric measurement (biparietal diameter, abdominal circumference, or femur length) below the fifth percentile in the second trimester. RESULTS: Of 98 fetuses with trisomy 18, 95 (97%) were detected sonographically; an anomaly was found in 92 (94%). A biometric measurement below the fifth percentile was noted in 50 (51%). Cardiac (63%) and central nervous system (34%) anomalies were most frequently detected. Although choroid plexus cysts were commonly seen, no fetuses with trisomy 18 and isolated choroid plexus cysts were found. CONCLUSIONS: Targeted sonography identified abnormal fetal anatomy or abnormal biometric findings in 97% of fetuses with trisomy 18 in the second trimester. A biometric measurement below the fifth percentile was noted in half of the cases in the second trimester.     

Congenital lung malformations in the second trimester: prenatal ultrasound diagnosis and pathologic findings

PURPOSE: To correlate prenatal sonographic diagnosis of cystic lung malformations with fetopathologic findings after termination of pregnancy. METHODS: We retrospectively analyzed the data of 16 terminated cases in which a cystic lung lesion was diagnosed pre- or postnatally. RESULTS: On average, prenatal diagnosis was established on the 21(st) gestational week (range, 19-26 weeks). The cause of termination was severe polyhydramnios in 4 cases, nonimmune fetal hydrops in 4 cases, other congenital malformation in 5 cases (renal malformation, 2 cases; congenital diaphragmatic hernia, 3 cases), and obstetrical conditions (intrauterine death, placental abruption, spontaneous abortion) in 3 cases. In 11 cases, congenital cystic adenomatoid malformation (CCAM) was the presumptive prenatal diagnosis. Autopsy confirmed the prenatal diagnosis in 6 of them, while in the other 5 cases, an enteric cyst, a laryngeal atresia, an unidentified tumor, a pulmonary hypoplasia, and an extralobar pulmonary sequestration were found on histologic examination. On the other hand, the autopsy revealed CCAM in those 5 cases in which other malformations were suggested prenatally. CONCLUSION: The prenatal sonographic diagnosis of CCAM is difficult. Our cases emphasize the important role of fetopathology even today in the verification of prenatal diagnosis based on sonographic examinations.     

Three-dimensional ultrasound evaluation of short-rib polydactyly syndrome type II in the second trimester: a case report.

Prenatal diagnosis of short-rib polydactyly syndrome is possible and has been reported in literature, but a precise ultrasound diagnosis is not easy. We report a case in which three-dimensional ultrasound was used in the evaluation of the disorder. The contribution and potential application of three-dimensional sonography in the prenatal diagnosis of short-rib polydactyly syndrome and other fetal skeletal malformations is discussed.     

超声在诊断孕中期完全性子宫破裂中的价值

目的探讨超声在诊断孕中期完全性子宫破裂中的价值。 方法选取2010年至2019年在首都医科大学附属北京妇产医院收治的经手术证实的8例孕中期完全性子宫破裂患者,对8例患者的术前超声声像图特点及临床资料进行回顾性分析。 结果8例病例均存在异常超声表现,且复杂多样。结合高危因素及临床表现,超声明确诊断子宫破裂2例、先兆子宫破裂1例,可疑子宫破裂4例,误诊胎盘早剥1例。 结论超声是诊断孕中期完全性子宫破裂的重要方法,可为临床诊断提供依据和参考。     

Three-dimensional ultrasound: a novel technique for investigating the urethral sphincter in the third trimester of pregnancy.

OBJECTIVES: To measure urethral sphincter volume by three-dimensional (3D) ultrasound. To assess the reproducibility of this measurement technique and to compare volumes obtained using 3D ultrasound with volumes calculated from a formula based on 2D ultrasound measurements. METHODS: Women were recruited as part of an ongoing study of changes to the pelvis resulting from pregnancy and childbirth. One hundred and eleven women in the third trimester of pregnancy (between 32 and 41 completed weeks' gestation) underwent a 3D transvaginal ultrasound scan of the urethra. In 10 cases the scan was analyzed twice by different observers to assess the reproducibility of the measurements from the scans and the results were analyzed using limits of agreement. RESULTS: The interobserver error was consistent between all the linear, 2D and 3D measurements obtained from the area scanned. There was a significant difference between volumes calculated directly by 3D ultrasound and the approximated volumes from conventional 2D measurements. CONCLUSIONS: Three-dimensional ultrasound appears to be a useful tool in measuring urethral sphincter volume. The error is consistent with that of linear and 2D imaging. However, the increase in normal range generated by biological variation in all three planes makes 3D ultrasound a more sensitive method of evaluating change to the urethral sphincter.     

iworks智能工作流对孕中期超声检查质量的影响

目的 观察iworks智能工作流用于孕中期超声检查流程优化及质量控制的价值.方法 纳入2658胎在20家产前诊断中心接受孕中期超声检查胎儿,根据检查方法将其分别纳入iworks组(n=1394)和非iworks组(n=1264).对iw o rks组胎儿,医师根据iw o rks要求进行检查并存储42个标准切面;对非i...     

Uterine artery resistance and anxiety in the second trimester of pregnancy.

OBJECTIVE: To investigate the association between maternal anxiety and uterine artery resistance index (RI) at 20 weeks of gestation. METHODS: Uterine artery blood flow was assessed using color Doppler ultrasound and maternal anxiety was measured using the Hospital Anxiety and Depression (HAD) scale in 96 healthy primigravid women attending consecutively for their routine 20-week anomaly scan. RESULTS: The mean uterine artery RI was 0.54 (95% confidence interval, 0.52-0.56) and the median HAD anxiety score was 6 (range, 0-20). There was no association between RI and anxiety scores (r = 0.09, P = 0.36). Women scoring as definite cases of anxiety did not have a significantly elevated uterine artery RI or increased frequency of waveform notching compared to women with doubtful or no anxiety. CONCLUSIONS: The data of this study do not suggest a significant association between maternal anxiety and uterine artery RI at 20 weeks of gestation in healthy primigravid women with normally developing pregnancies. A prospective cohort study would be useful to determine the nature of the relationship between maternal anxiety, alteration in uterine artery blood flow and abnormal pregnancy outcome.     

Three-dimensional multiplanar transvaginal ultrasound of the cervix in pregnancy.

OBJECTIVES: To develop a standard technique for using three-dimensional ultrasound (3D US) to study and evaluate the cervix in pregnant women at high risk for premature delivery, comparing the findings on 3D US with those on conventional two-dimensional ultrasound (2D US). STUDY DESIGN: Twenty-one pregnant women at high risk for premature delivery had a total of 37 transvaginal 2D and 3D US examinations of the cervix between 11 and 32 weeks' gestation. A 3D US vaginal probe (5.0-8.0 MHz, Voluson 530D, Medison, Pleasanton, CA, USA) was used. Measurements made from the 2D and 3D US were compared. RESULTS: Of the 37 cervical length measurements in 3D US sagittal plane, seven were shorter and three were longer than on 2D US (varying by 5-15 mm) indicating that the true mid-sagittal plane was not obtained in ten (27%) of the 37 2D US examinations. Of 21 examinations showing funneling, funneling was seen on both 2D and 3D US in 15, but was seen only on 3D US in six. There was a significant (P < 0.05) difference between funnel width as measured in the coronal 3D plane versus 2D US, as well as between funnel width in the coronal 3D US plane versus sagittal 3D US plane (P < 0.05). The cerclage was seen in its entirety in nine of 10 examinations; the 3D US axial plane was most valuable for imaging the cerclage. CONCLUSIONS: 3D US appears to offer a more complete assessment of the cervix than 2D US. Multiplanar correlation shows that the standard 2D US sagittal view may under- or over-estimate cervical length. Our preliminary data suggest that 3D US has the potential to improve our understanding of cervical morphology.     

二维超声诊断参数在中孕期主动脉缩窄胎儿中的应用

目的 探讨二维超声诊断胎儿主动脉缩窄（COA）的直接和间接指标的应用价值。方法 回顾性分析经胎儿超声心动图检查诊断、并经出生后或尸体检查证实为COA的中孕期胎儿18胎。以主动脉峡部Z分数（Z-AoI）<-2、主动脉峡部内径（AoId）≤2.0 mm、主肺动脉内径/升主动脉内径（MPAd/AAOd）≥1.6、二尖瓣环横径/三尖瓣环横径（MVd/TVd）<0.6为诊断标准,分别分析其诊断符合率,同时测量主动脉瓣环内径（AOd）,计算中孕期COA胎儿AOd的参考范围。结果 在18胎COA胎儿中,Z-AoI、AoId、MPAd/AAOd、MVd/TVd的诊断符合率分别为94.44%（17/18）、61.11%（11/18）、66.67%（12/18）、44.44%（8/18）,差异有统计学意义（P<0.05）。COA胎儿AOd的参考范围为2.60~2.98 mm。结论 Z-AoI诊断COA的符合率最高;中孕期COA胎儿AOd为2.60~2.98 mm。     

Three-dimensional sonographic findings of a cervical pregnancy.

A cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. The current diagnostic modality of this potentially life-threatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.     

Automated retrieval of standard diagnostic fetal cardiac ultrasound planes in the second trimester of pregnancy: a prospective evaluation of software.

OBJECTIVE: To evaluate prospectively the performance of software that automatically retrieves, from a three-dimensional (3D) volume of the fetal chest, three diagnostic cardiac planes in the second trimester of pregnancy. METHODS: 3D static volumes of the fetal chest were acquired at the level of the four-chamber view in 72 fetuses between 18 and 23 weeks of gestation. Standardization of 3D volumes was performed in Plane A (the reference plane: four-chamber view) alone. Tomographic ultrasound imaging (TUI) was added to the display of each diagnostic plane. The left ventricular outflow plane (Cardiac plane 1: five-chamber view, aorta), the right ventricular outflow plane (Cardiac plane 2: pulmonary artery) and the abdominal circumference plane (Cardiac plane 3: abdominal circumference, stomach) were retrieved by the software from the 3D volumes and the data were analyzed to determine whether Cardiac planes 1-3 were displayed correctly in each volume. RESULTS: The automated software displayed, in at least one TUI plane, target Cardiac plane 1 in 94.4% of volumes, target Cardiac plane 2 in 91.7% of volumes and target Cardiac plane 3 in 97.2% of volumes. CONCLUSION: Our results validate the concept of automated sonography and its potential clinical applicability.     

Three-dimensional ultrasonographic technology to assess and compare echodensity of fetal bowel,bone, and liver in the second trimester of pregnancy.

Increased fetal bowel echogenicity in the second trimester is used as a marker for prenatal diagnosis of Down syndrome. The diagnosis of hyperechogenicity is subjective. We sought to quantify and correlate fetal bowel echogenicity with liver and bone in 47 normal fetuses, using three-dimensional ultrasonographic technique and objective measurement of gray scale distribution. No significant change was found in the organs' echogenicity between 15 and 24 weeks of gestation, the optimal time for detection of fetal chromosomal anomalies. A wide variability in bowel density was noted within the normal group, which could explain its poor sensitivity for the detection of Down syndrome. Bowel echodensity correlates better with liver density than with bone density. Thus, comparison of bowel to liver echogenicity, even with two-dimensional sonography, may prove to be a more effective clinical tool in the evaluation of fetal intra-abdominal echodensities.     

多胎妊娠中期选择性减胎术的护理

目的探讨妊娠中期B超引导下经腹或经阴道选择性减胎术的护理。方法针对错过早期妊娠选择性减胎术的三胎妊娠患者进行了中期妊娠选择性减胎术的患者,手术前做好心理护理、协助定位、术中做好手术配合并指导孕妇密切配合手术,术后监测被保留胎儿生长发育及孕妇凝血功能情况。总结术前、术中、术后的护理经验。结果在护理措施的配合下,4例减胎术全部获得成功,被减胎儿逐渐吸收缩小,保留胎儿生长发育良好。结论多胎妊娠中期经腹或者经阴道选择性减胎,是治疗由于错过早期妊娠选择性减胎术的多胎妊娠患者减胎的安全有效的措施。