First‐Trimester Assessment of the Fetal Palate

We describe a new technique that can facilitate the first‐trimester examination of the fetal palate using the Volume NT algorithm (Samsung Medison, Seoul, Korea), a program that automatically detects the exact midsagittal plane of the head and is primarily designed for semiautomatic measurement of the nuchal translucency thickness. Three‐dimensional (3D) data sets from the fetal face were captured with Volume NT and subsequently reformatted with the Oblique View software to obtain orthogonal views of the primary and secondary palate in coronal and axial planes, respectively. By testing this method in selected 3D data sets obtained retrospectively (n = 12) and prospectively (n = 28), we were able to extract clinically acceptable views of the fetal palate in all cases. This preliminary report shows that with this new 3D automation development, early evaluation of the fetal palate is feasible and reproducible and could be easily incorporated into the first‐trimester sonographic protocol once its ability to detect abnormal cases is demonstrated.     

The Value of Routine Early Pregnancy Ultrasound in the Antenatal Booking Clinic

Summary: The value of routine antenatal booking ultasound as an adjunct to, or as an alternative to the 18 to 20 week ultrasound, is not known. A study into the possible benefits of routine antenatal booking ultrasound was undertaken. One year's experience, involving 1,372 scans is described. The main medical benefits include the establishment or correction of gestational age (41.7% of all pregnancies) and the identification of multiple pregnancies (0.7%), nonviable pregnancies (1.4%) and other pregnancies requiring specialist antenatal clinic referral (0.7%), resulting in a total of 44.5% of patients in whom some benefit was obtained.     

Successful Outcome with Serial Amniocenteses for Polyhydramnios Complicating Cystic Adenomatoid Malformation of the Lung

Summary: Hydrops fetalis secondary to congenital cystic adenomatoid malformation of the fetal lung is almost invariably a lethal condition. This poor prognosis may be attributed to the combined effects of tissue compression from the thoracic space occupying lesion and premature delivery of a hydropic baby following rupture of the membranes in the presence of polyhydramnios. We describe a successful outcome with serial amniocenteses. Partial in utero resolution of the lung lesion with complete return to normal of the aberrant liquor volume was documented, and a live infant was delivered at term.     

Survey of echocardiography practice across five continents

Background and Aim

The term echocardiography refers to a diverse range of cardiovascular ultrasound imaging methods, both inside and outside specialist cardiology practice. While guidelines exist, we hypothesized that there are significant worldwide differences in the way echocardiography is practiced. We surveyed echocardiography practitioners around the world to characterize the workforce and their practice.

Method

Social media and word of mouth were used in an explosive sampling approach to recruit echo users, who then completed an online survey that included personal demographics and questions about their practice, their resources, and daily use of echocardiography.

Results

In total, 594 participants completed the survey: 54.9% sonographers; 30% cardiologists, with the remainder other physicians or trainees. Significant variation in the number of echoes performed and the time allocated to scanning was observed. There were also differences in the gathering of adjunct measures such as blood pressure and body size.

Conclusion

There is wide variation in echocardiography practices across the world. Differences are likely to be both clinician- and healthcare system-driven. Guidelines for practice developed in well-resourced western countries and intended for use in cardiology-based echocardiography laboratories may not be applicable to other countries or indeed to new echo users.