An effective ultrasound fetal palate screening software based on the "sequential sector scan through the oral fissure" and three-dimensional ultrasound.

BACKGROUND: Orofacial clefts are one of the most common congenital malformations of the fetal face and ultrasound is mainly responsible for its diagnosis. It is difficult to view the fetal palate, so there is currently no unified standard for fetal palate screening, and the diagnosis of cleft palate is not included in the relevant prenatal ultrasound screening guidelines. Many prenatal diagnoses for cleft palate are missed due to the lack of effective screening methods. Therefore, it is imperative to increase the display rate of the fetal palate, which would improve the detection rate and diagnostic accuracy for cleft palate. We aim to introduce a fetal palate screening software based on the "sequential sector scan though the oral fissure", an effective method for fetal palate screening which was verified by our follow up results and three-dimensional ultrasound and to evaluate its feasibility and clinical practicability. METHODS: A software was designed and programmed based on "sequential sector scan through the oral fissure" and three-dimensional ultrasound. The three-dimensional ultrasound volume data of the fetal face were imported into the software. Then, the median sagittal plane was taken as the reference interface, the anterior upper margin of the mandibular alveolar bone was selected as the fulcrum, the interval angles, and the number of layers of the sector scan were set, after which the automatic scan was performed. Thus, the sector scan sequential planes of the mandibular alveolar bone, pharynx, soft palate, hard palate, and maxillary alveolar bone were obtained in sequence to display and evaluate the palate. In addition, the feasibility and accuracy of the software in fetal palate displaying and screening was evaluated by actual clinical cases. RESULTS: Full views of the normal fetal palates and the defective parts of the cleft palates were displayed, and relatively clear sequential tomographic images and continuous dynamic videos were formed after the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software. CONCLUSIONS: The software can display fetal palates more directly which might allow for a new method of fetal palate screening and cleft palate diagnosis.

The value of real-time shear wave elastography in spontaneous preterm birth.

This study aimed to investigate the predictive value of real-time shear wave elastography (SWE) for spontaneous preterm birth (SPB). This study prospectively selected 175 women with singleton pregnancies at 16 to 36 weeks of gestation. Cervical length (CL) and uterocervical angle (UCA) were measured using transvaginal ultrasonography. Real-time shear wave elastography was used to measure Young's modulus values, including the average Young's modulus (Emean) and the maximum Young's modulus (Emax) at 4 points: point A on the inner lip of the cervical os, point B on the outer lip of the cervical os, point C on the inner lip of the external os, and point D on the outer lip of the external os. Receiver operating characteristic (ROC) curve analysis was performed to compare the accuracy of Young's modulus values at the 4 points, CL, and UCA in predicting SPB. Significant variables were used to construct a binary logistic regression model to predict the multifactorial predictive value of SPB, which was evaluated using an ROC curve. A total 176 valid cases, including 160 full-term pregnancies and 16 SPB, were included in this study. Receiver operating characteristic curve analysis revealed that Emean at point A, as well as Emean and Emax at point D, had a relatively high accuracy in diagnosing SPB, with area under the curve values of 0.704, 0.708, and 0.706, respectively followed by CL (0.670), SWE at point C (Emean 0.615, Emax 0.565), SWE at point B (Emean 0.577, Emax 0.584), and UCA (0.476). Binary logistic regression analysis showed that comorbidities during pregnancy (including diabetes mellitus, hypertension, cholestasis and thyroid dysfunction), CL, and Emean at point A were independent predictors of preterm birth. In addition, the AUC value of the logistic regression model's ROC curve was 0.892 (95% CI: 0.804-0.981), with a sensitivity of 0.867, specificity of 0.792, and Youden's index of 0.659, indicating that the regression model has good predictive ability for SPB. Real-time shear wave elastography showed a higher predictive value for SPB than CL and UCA. The SWE combined with CL and comorbidities during pregnancy model has a good predictive ability for SPB.

Evaluation and Significance of Nonvisualization of the Cavum Septum Pellucidum on Prenatal Ultrasonography.

Importance: The identification of the cavum septum pellucidum (CSP) is an integral part of the routine second trimester fetal anatomy scan. The absence or nonvisualization of the CSP has significant clinical implications and requires further evaluation and counseling for the pregnant patient. Objective: The aim of this review is to review the importance of accurate sonographic identification of the CSP and the underlying pathologies that can be associated with nonvisualization of this structure. Evidence Acquisition: A literature review was performed with PubMed using key words including CSP, fetal anatomy ultrasound, and fetal anomalies. Results: The absence of the CSP is associated with several central nervous system pathologies, all with a wide range of phenotypic outcomes, ranging from normal to very severe or lethal. Relevance: Most obstetrician-gynecologists will have a patient in whom a CSP is not identified on fetal ultrasound. Thus, it is imperative to have a general understanding of this relatively common entity.

The establishment and severity assessment of ultrasound-guided prenatal bronchopulmonary dysplasia model in rat.

To study a new method for establishing animal models of prenatal bronchopulmonary dysplasia (BPD), we used lung ultrasound score (LUS) to semi-quantitatively assess the severity of lung lesions in model rats. Lipopolysaccharide (LPS) was injected into the right lung of the fetus of the rat under ultrasound-guided, and the right lung of the neonates were scanning for LUS. Specimens were collected for pathological scoring and detection of pulmonary surfactant-associated glycoprotein (SP)-C and vascular endothelial growth factor (VEGF) expression quantity. The correlation between LUS and pathological scores was analyzed. (1) The animal models were consistent with the pathological manifestations of BPD. (2) It showed a strong positive correlation between LUS and pathological scores in animal models (r = 0.84, P < 0.005), and the expression quantity of SP-C and VEGF in lung tissue were decreased (both P < 0.05). Animal models established by ultrasound-guided puncture of the lung of rats and injection of LPS were consistent with the manifestation of BPD. This method could be used to establish animal models of BPD before birth, and the severity of BPD could be assessed by using LUS.

[Application of Fetal Magnetic Resonance Imaging in Prognosis Assessment of Fetuses With Congenital Pulmonary Cystic Diseases]. / äº§å‰ç£å ±æŒ¯åœ¨å ˆå¤©æ€§è‚ºå›Šæ€§ç–¾ç— èƒŽå„¿é¢„åŽè¯„ä¼°ä¸­çš„åº”ç”¨ç ”ç©¶.

Objective: The aim of this study is to explore the practical value of prenatal magnetic resonance imaging (MRI) in the assessment of congenital cystic lung disease in fetuses, to evaluate the relative size of the lesion and the status of lung development, and to make an attempt at utilizing the strength of MRI in post-processing to obtain assessment indicators of the size of the lesion and the status of lung development, with which predictions can be made for the prognosis that these fetuses may face after birth. We retrospectively collected and analyzed the data of fetuses diagnosed with congenital cystic lung disease. Prenatal ultrasound examination of these fetuses led to the diagnosis that they were suspected of having congenital cystic lung disease and the diagnosis was confirmed by subsequent prenatal MRI. The fetuses were followed up to track their condition at birth (postnatal respiratory distress, mechanical ventilation, etc.), whether the fetuses underwent surgical treatment, and the recovery of the fetuses after surgical treatment. The recovery of the fetuses was followed up to explore the feasibility of prenatal MRI examination to assess fetal congenital pulmonary cystic disease, and to preliminarily explore the predictive value of prenatal MRI for the prognosis of fetuses with congenital pulmonary cystic disease. Methods: MRI fetal images were collected from pregnant women who attended the West China Second University Hospital of Sichuan University between May 2018 and March 2023 and who were diagnosed with fetal congenital pulmonary cystic disease by prenatal ultrasound and subsequent MRI. Fetal MRI images of congenital cystic lung disease were post-processed to obtain the fetal lung lesion volume, the fetal affected lung volume, the healthy lung volume, and the fetal head circumference measurements. The signal intensity of both lungs and livers, the lesion volume/the affected lung volume, the lesion volume/total lung volume, the cystic volume ratio (CVR), and the bilateral lung-liver signal intensity ratio were measured. The feasibility and value of MRI post-processing acquisition indexes for evaluating the prognosis of fetuses with congenital cystic lung disease were further analyzed by combining the follow-up results obtained 6 months after the birth of the fetus. Logistic regression models were used to quantify the differences in maternal age, gestational week at the time of MRI, CVR, and bilateral lung-to-liver signal intensity ratio, and to assess whether these metrics correlate with poor prognosis. Receiver operating characteristic (ROC) curves were used to assess the value of the parameters obtained by MRI calculations alone and in combination with multiple metrics for predicting poor prognosis after birth. Results: We collected a total of 67 cases of fetuses diagnosed with congenital cystic lung disease by fetal MRI between May 2018 and March 2023, and excluded 6 cases with no normal lung tissue in the affected lungs, 11 cases of fetal induction, and 3 cases of loss of pregnancy. In the end, 47 cases of fetuses with congenital cystic lung disease were included, of which 30 cases had a good prognosis and 17 cases had a poor prognosis. The difference in the difference between the signal intensity ratios of the affected and healthy sides of the lungs and livers of the fetuses in the good prognosis group and that in the poor prognosis group was statistically significant (P<0.05), and the signal intensity ratio of the healthy side of the lungs and livers was higher than the signal intensity ratio of the affected side of the lungs and livers. Further analysis showed that CVR (odds ratio [OR]=1.058, 95% confidence interval [CI]: 1.014-1.104), and the difference between the lung-to-liver signal intensity ratios of the affected and healthy sides (OR=0.814, 95% CI: 0.700-0.947) were correlated with poor prognosis of birth in fetuses with congenital cystic lung disease. In addition, ROC curve analysis showed that the combined application of lesion volume/affected lung volume and the observed difference in the signal intensity ratio between the affected and healthy lungs and liver predicted the prognosis of children with congenital cystic lung disease more accurately than the single-parameter judgment did, with the area under the curve being 0.988, and the cut-off value being 0.33, which corresponded to a sensitivity of 100%, a specificity of 93.3%, and a 95% CI of 0.966-1.000. Conclusions: Based on the MRI of fetuses with congenital cystic lung disease, we obtained information on lesion volume, lesion volume/affected lung volume, lesion volume/total lung volume, CVR, and bilateral lung-to-liver signal intensity ratio difference, all of which showing some clinical value in predicting the poor prognosis in fetuses with congenital cystic lung disease. Furthermore, among the combined indexes, the lesion volume/affected lung volume and bilateral lung-to-liver signal intensity ratio difference are more effective predictors for the poor prognosis of fetuses with congenital cystic lung disease, and show better efficacy in predicting the poor prognosis of fetuses with congenital cystic lung disease. This provides a new and effective predictive method for further assessment of pulmonary lung development in fetuses with congenital cystic lung disease, and helps improve the assessment and prediction of the prognosis of fetuses with congenital cystic lung disease.

[Analysis of Prenatal Ultrasound Manifestations in 15 Cases of Cantrell Syndrome]. / Cantrell综合征15ä¾‹äº§å‰è¶ å£°è¡¨çŽ°åˆ†æž.

Objective: Cantrell syndrome, a rare congenital disorder, is characterized by a unique collection of defects on the midline abdominal wall, the lower sternum, the anterior diaphragm, and the diaphragmatic pericardium in addition to some form of intracardiac defect. So far, most of the reports on fetuses with Cantrell syndrome worldwide are either case reports or literature reviews, and few comprehensive studies on fetuses with Cantrell syndrome have been reported, especially in domestic literature. This study aims to provide a detailed analysis of 15 cases of Cantrell syndrome fetuses, focusing on their prenatal ultrasound manifestations and postnatal examination outcomes. Methods: A retrospective analysis was conducted with 15 cases of fetuses diagnosed with Cantrell syndrome via prenatal ultrasound examinations between March 2018 and July 2023. Ultrasound examinations were performed in accordance with the Guidelines for Obstetric Ultrasound in China, including first-trimester fetal ultrasound scan and routine second-trimester fetal ultrasound scan. Gestational age was evaluated and nuchal translucency (NT) was measured during first-trimester fetal ultrasound scan at 11 to 13+6 weeks. The diagnostic criterion for NT thickening was NT≥3.0 mm and the screening of severe fetal structural malformations was performed, including the screening of the head, the neck, the thorax, the abdominal content, the abdominal wall, the limbs and other structures. During routine second-trimester fetal ultrasound scan, the fetal biometry was assessed and an anatomy survey was performed. Post-induction and postnatal outcomes of fetuses diagnosed with Cantrell syndrome by prenatal ultrasound were followed up by postnatal observation, inquiries with the electronic medical record system, or telephone follow-up. The prenatal ultrasound imaging manifestations and features of the fetuses with Cantrell syndrome, as well as their post-induction or postnatal examination results were comprehensively summarized and analyzed. Results: The study involved pregnant women of the average age of 30.1±3.5 years, with ultrasound diagnoses made between 11 to 26 weeks of gestation (mean: 13.4±4.0 weeks). Among the 15 cases, there were 10 singleton pregnancies and 5 cases of one twin in a pair of twins. These twins comprised 3 monochorionic diamniotic twins and 2 dichorionic diamniotic twins, with Cantrell syndrome present in one of the twins in all 5 cases. Thirteen cases were diagnosed by fetal ultrasound scan conducted in the first trimester, with 10 being singleton pregnancies and 3 being twin pregnancies (1 monochorionic diamniotic twins and 2 dichorionic diamniotic twins). One case was missed in the first-trimester ultrasound scan, resulting in a missed diagnosis rate of 7.1%. Two cases were diagnosed in second-trimester fetal ultrasound scan, both involving monochorionic diamniotic twins. One case was a referral from another hospital at 19 weeks, while the other was initially not diagnosed for Cantrell syndrome and was diagnosed at 26 weeks. Prenatal ultrasound examinations revealed a consistent pattern of abnormalities across all 15 fetuses, including manifestations of ectopic cordis combined with abdominal protrusion mass. Specifically, 4 cases were diagnosed with omphalocele, 4 with gastroschisis, and the remaining 7 had uncertain coverage of the membrane on the surface of the abdominal protrusion mass. Six fetuses had complete ectopic cordis, while nine had partial ectopic cordis. Fetal echocardiography was performed in 5 cases, revealing intracardiac malformations in 4 cases (80%). Notably, 2 cases were diagnosed in the second trimester, including one with right ventricular hypoplasia accompanied by interventricular septal defect and another with double outlet right ventricle accompanied by interventricular septal defect. Additionally, 2 cases were diagnosed in the first trimester, one with single atrium and single ventricle, and the other with complete transposition of the great arteries. Of the 15 cases of fetuses with Cantrell syndrome, 13 (86.7%) exhibited concomitant malformations in other systems. These included 7 cases of spinal malformations, 4 limb abnormalities, 3 umbilical cord abnormalities, 2 central nervous system malformations, 1 facial malformation, and 2 fetal hydrops. Spinal malformations were the most prevalent concomitant malformation, accounting for 46.7% of all cases. Among the 14 fetuses undergoing NT examination, 7 (50%) had increased NT, and 5 of them had cystic hygroma. All 10 singleton pregnancies underwent induced abortion, and the appearance of the induced fetuses was consistent with the prenatal ultrasound manifestations. In the twin pregnancies, 2 cases experienced intrauterine fetal death, while 2 underwent selective reduction. Notably, 3 of these cases exhibited postnatal appearances consistent with prenatal ultrasound manifestation, while 1 case showed an indistinct appearance after selective reduction during delivery. One case was lost to follow-up. Genetic testing was conducted for 4 induced fetuses, none of which yielded any relevant pathogenic or potentially pathogenic variants. Conclusion: In conclusion, Cantrell syndrome manifests prenatally with ectopic cordis combined with abdominal protrusion mass, often accompanied by intracardiac malformations and other concomitant malformations. While most cases can be diagnosed in the first trimester, there remains the possibility of missed diagnoses, which underscores the importance of close follow-up in the second trimester.

Intrauterine growth in chromatinopathies: A long road for better understanding and for improving clinical management.

BACKGROUND: Chromatinopathies are a heterogeneous group of genetic disorders caused by pathogenic variants in genes coding for chromatin state balance proteins. Remarkably, many of these syndromes present unbalanced postnatal growth, both under- and over-, although little has been described in the literature. Fetal growth measurements are common practice in pregnancy management and values within normal ranges indicate proper intrauterine growth progression; on the contrary, abnormalities in intrauterine fetal growth open the discussion of possible pathogenesis affecting growth even in the postnatal period. METHODS: Among the numerous chromatinopathies, we have selected six of the most documented in the literature offering evidence about two fetal overgrowth (Sotos and Weaver syndrome) and four fetal undergrowth syndromes (Bohring Opitz, Cornelia de Lange, Floating-Harbor, and Meier Gorlin syndrome), describing their molecular characteristics, maternal biochemical results and early pregnancy findings, prenatal ultrasound findings, and postnatal characteristics. RESULTS/CONCLUSION: To date, the scarce data in the literature on prenatal findings are few and inconclusive, even though these parameters may contribute to a more rapid and accurate diagnosis, calling for a better and more detailed description of pregnancy findings.

Comparing Pre-Induction Ultrasound Parameters and the Bishop Score to Determine Whether Labor Induction Is Successful.

Background and Objectives: The incidence of labor induction is steadily increasing worldwide. The main aim of this study was to evaluate the ultrasound parameters and their mutual correlation and to analyze the parameters' predictive capability in assessing the success of labor induction. The secondary goal was to assess patients' tolerability and acceptance of transvaginal ultrasound and digital gynecological examination. Materials and Methods: This prospective observational follow-up study included 252 women selected for labor induction. The transvaginal ultrasound examination measured the posterior cervical angle, cervical length, the length and width funneling of the cervix, the distance between the head of the fetus and the external uterine os, and the position of the fetal occiput. After the ultrasound, a digital vaginal examination was performed (according to the Bishop score), and the women were asked to rate their perception of pain for each procedure. Results: The most common indication for labor induction was post-term pregnancy (57.59%), and the most common method of labor induction was oxytocin with amniotomy (70%). The results showed that a significant independent prediction of vaginal delivery could be provided based on the Bishop score and cervical length. Other investigated ultrasound parameters, the length and width of the funneling of the cervix (p < 0.001), the fetal head stage (p < 0.001), and the size of the posterior cervical angle (p < 0.05), showed statistical significance in relation to the success of labor induction. Patients reported lower discomfort and pain during transvaginal ultrasound examination (mean score 2, IQR 3) compared to digital examination (mean score 5, IQR 4), with p < 0.001. Conclusions: The results imply that the assessment of ultrasound parameters before induction of labor is necessary to predict the outcome and reduce the possibility of complications. In terms of tolerability and choice by the patients, the transvaginal ultrasound examination was better rated than the vaginal gynecological examination.

Ensemble learning for fetal ultrasound and maternal-fetal data to predict mode of delivery after labor induction.

Providing adequate counseling on mode of delivery after induction of labor (IOL) is of utmost importance. Various AI algorithms have been developed for this purpose, but rely on maternal-fetal data, not including ultrasound (US) imaging. We used retrospectively collected clinical data from 808 subjects submitted to IOL, totaling 2024 US images, to train AI models to predict vaginal delivery (VD) and cesarean section (CS) outcomes after IOL. The best overall model used only clinical data (F1-score: 0.736; positive predictive value (PPV): 0.734). The imaging models employed fetal head, abdomen and femur US images, showing limited discriminative results. The best model used femur images (F1-score: 0.594; PPV: 0.580). Consequently, we constructed ensemble models to test whether US imaging could enhance the clinical data model. The best ensemble model included clinical data and US femur images (F1-score: 0.689; PPV: 0.693), presenting a false positive and false negative interesting trade-off. The model accurately predicted CS on 4 additional cases, despite misclassifying 20 additional VD, resulting in a 6.0% decrease in average accuracy compared to the clinical data model. Hence, integrating US imaging into the latter model can be a new development in assisting mode of delivery counseling.

Prenatal ultrasound diagnosis and quality control of fetal nuchal translucency. / èƒŽå„¿é¢ˆé¡¹é€æ˜Žå±‚äº§å‰è¶ å£°è¯Šæ–­åŠè´¨é‡æŽ§åˆ¶.

OBJECTIVES: In clinical ultrasound examinations, it is challenging to perform quality control on the images of each fetal nuchal translucency (NT) and crown-rump length (CRL). However, small measurement differences can increase the probability of false-positive or false-negative diagnosis. Therefore, it is necessary to establish a quality control system for fetal NT examination. This study aims to control the quality of fetal NT and CRL measurements, evaluate the accuracy of ultrasound physicians in early pregnancy NT measurements, and analyze the impact of increased fetal structure screening on the detection rate of chromosomal abnormalities. METHODS: Data were collected from cases before and after 12 months of NT examination quality control, with 2 214 before quality control and 2 538 cases after quality control. Three quality control data metrics were analyzed: NT multiple of median (NT-MoM), standard deviation (SD) of log10MoM [(SD) log10MoM], and the slope of NT on CRL (SNC). The performance of NT measurements was monitored through the individual CRL NT-MoM within the 0.9-1.1 MoM range of the normal median curve, while grouped based on different years of experience (<3 years, 3-6 years, >6 years), and NT-MoM values among these groups were compared. Data on NT thickening, structural anomalies, and chromosomal abnormalities were retrospectively analyzed during the quality control period. RESULTS: According to the curve equation of the American NTQR project group, the NT-MoM value before quality control was 0.921 7 MoM, the (SD) log10MoM value was 0.091 92, and the SNC value was 12.20%. After quality control, the NT-MoM value was 0.948 3 MoM, the (SD) log10MoM value was 0.094 81, and the SNC value was 11.43%. The comparison of NT-MoM values before and after quality control showed a statistically significant difference (P<0.000 1). The comparison of NT-MoM values measured by ultrasound physicians with different years of experience before and after quality control also showed statistically significant differences (P<0.000 1). The NT-MoM values for the 3-6 years and >6 years groups were higher after quality control (P<0.05), while the <3 years group showed no significant difference before and after quality control (P>0.05). After quality control, cases of NT thickening without significant structural abnormalities accounted for 19.05%, NT thickening with structural abnormalities accounted for 47.62%, and NT normal with structural abnormalities accounted for 33.33%. There were 36 cases of fetal heart abnormalities, accounting for 20.34% of the total abnormality rate, with a positive rate of 36% in chromosome tests. CONCLUSIONS: After quality control, ultrasound physicians measure NT more accurately, but differences among measurements remain. Measurements by experienced ultrasound physicians are closer to expected values, usually lower than expected. Monitoring fetal NT and CRL measurements helps improve measurement accuracy. Increasing structural screening during NT examinations, especially for the fetal heart, enhances the detection rate of chromosomal abnormalities.

Review of speckle tracking analysis to measure the size, shape, and contractility of the fetal heart in fetuses with congenital heart defects.

Evaluation of the fetal heart involves two approaches. The first describes a screening protocol in which the heart is imaged in transverse planes that includes the four-chamber view (4CV), left and right outflow tracts, and the 3-vessel-tracheal view. The second approach is a fetal echocardiogram that requires additional cardiac images as well as evaluating ventricular function using diagnostic tools such as M-mode and pulsed Doppler ultrasound. Speckle tracking analysis of the ventricular and atrial endocardium of the fetal heart has focused primarily on computing longitudinal global strain. However, the technology enabling this measurement to occur has recently been adapted to enable the clinician to obtain numerous additional measurements of the size, shape, and contractility of the ventricles and atrial chambers. By using the increased number of measurements derived from speckle tracking analysis, we have reported the ability to screen for tetralogy of Fallot, D-transposition of the great arteries (D-TGA), and coarctation of the aorta by only imaging the 4CV. In addition, we have found that measurements derived from speckle tracking analysis of the ventricular and atrial chambers can be used to compute the risk for emergent neonatal balloon atrial septostomy in fetuses with D-TGA. The purpose of this review is to consolidate our experience in one source to provide perspective on the benefits of speckle tracking analysis to measure the size, shape, and contractility of the ventricles and atria imaged in the 4CV in fetuses with congenital heart defects.

Ultrasound parameters of arteries and heart in normal fetuses.

BACKGROUND: Currently, no normal ultrasound data of the fetuses during the 20-40 gestation have been obtained for references of fetal growth and development. If such ultrasound data existed for prenatal diagnosis of possible diseases and abnormalities, neonates would be able to get timely treatment immediately after birth. This study was thus performed to obtain ultrasound parameters of normal fetuses during the 20-40 week gestation and the distribution of ultrasound parameters with the gestational age for references of detecting potential fetal diseases and abnormalities. METHODS: Normal fetuses without any abnormalities were enrolled, and the ultrasound parameters of the general biology, arteries, and aorta were measured and analyzed. RESULTS: 417 normal fetuses were enrolled. A significant (P < 0.05) negative correlation with the gestational age was detected in the peak systolic velocity/peak diastolic velocity (S/D), pulsatility index (PI) and resistance index (RI) of the umbilical artery (UA). A relatively stable relationship with the gestational age was detected in the fetal weight%, S/D, PI and RI of the middle cerebral artery (MCA), peak systolic velocity (PSV) and velocity time integral (VTI) of the intra-abdominal UA, fetal heart to chest ratio, mitral valve (MV)- and tricuspid valve (TV)-E/A peak flow velocity, aortic isthmic Z-score and displacement, distance between the brachiocephalic artery-left common carotid artery (BA-LCCA) and LCCA-left subclavian artery (LSA), Z-score of aorta, ascending aorta (AAO), pulmonary artery (PA), main pulmonary artery (MPA), and descending aorta (DAO). A significant (P < 0.05) positive correlation with the gestational age was detected in the fetal biological data, MCA PSV and VTI, free-UA PSV and VTI and cardio-thoracic ratio, cardiac parameters, ductus arteriosus (DA) and isthmus diameter, aortic parameters, PA and MPA diameter, MPA PSV and VTI, isthmus flow volume and velocity and PA flow volume, DA and BA parameters, and LCCA and LSA parameters (flow volume, PSV, and VTI). CONCLUSION: A certain correlation and distribution trend is detected in the ultrasound parameters of normal fetuses, and the ratios among different parameters remain relative stable. These findings can be used for determination of abnormal growth of the fetuses in prenatal ultrasound scan.

TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester.

INTRODUCTION: TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD. AIM: To test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix. METHOD: Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24 weeks who had one or more clinical risk factors for sPTD or CL <2.5 cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR - softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37 weeks (after 26 weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM-was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length. RESULTS: Out of 221 recruited,17 were lost to follow-up after 32 weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5 cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63 ± 0.67 vs. 3.63 ± 0.80, p = .981) whereas SRs in all three ROIs were significantly lower among sPTD group versus no sPTD group (IN:0.65 ± 0.29 vs 0.79 ± 0.30 p = .001, WN:0.34 ± 0.13 vs 0.39 ± 0.15, p = .013, AN:0.37 ± 0.16 vs 0.48 ± 0.26, p = .002, respectively). Using ROC curves, while CL was not predictive (AUROC 0.49, p = .81), SRs showed moderate predictive value toward sPTD with the best AUC of 0.624 (p = .003) at IN. Prediction was slightly better for early sPTD <32 weeks (AUC 0.653 p = 0.03). The best cutoff for SR at IN was 0.72, below which there was a moderate accuracy in predicting sPTD (sensitivity 52.11%, specificity 60.9%, PPV 41.57%, NPV 70.44%, diagnostic OR 1.69 and overall accuracy of 57.84%). A weak positive correlation is seen between IN and CL (Pearson's correlation R = 0.181). Multi-variable binary logistic regression analysis suggested that SRs at IN (Adjusted OR - 0.259 CI 0.079-0.850), AN (Adjusted OR 0.182 CI 0.034-0.963), Multiple Pregnancy (Adjusted OR 3.5 CI 1.51-8.13) and previous sPTD/PPROM (Adjusted OR 2.72 CI 0.97-7.61) independently predicted sPTD. CONCLUSIONS: TVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.

Fetal cerebral arteries in a new ultrasonographic perspective.

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Utility of the novel fetal heart quantification (fetal HQ) technique in diagnosing ventricular interdependence and biventricular dysfunction in a case of prenatally diagnosed Uhl's anomaly.

Uhl's anomaly is characterized by complete or partial absence of right ventricular myocardium. We describe a case of prenatally diagnosed Uhl's anomaly with biventricular dysfunction which was quantified with speckle tracking echocardiography using a novel fetal heart quantification (fetal HQ) technique.

Imaging Fetal Spine Malformations in the Context of In Utero Surgery.

This review covers the embryology, definition, and diagnosis of open spinal dysraphism with a focus on fetal ultrasound and MR imaging findings. Differentiating open versus closed spinal dysraphic defects on fetal imaging will also be discussed. Current fetal surgery practices and imaging findings in the context of fetal surgery are also reviewed.

Monochorionic Twin Complications and Fetoscopic Interventions.

Monochorionic twins are at risk for complications due to the presence of placental vascular anastomoses, including twin-twin transfusion syndrome, twin anemia-polycythemia sequence, selective fetal growth restriction, and twin reversed arterial perfusion sequence. While ultrasound is the primary modality to screen for the development of these complications, MRI plays an important role in assessing monochorionic twin pregnancies for the development of other complications, such as neurologic injury. In this article, the authors review the ultrasound imaging findings associated with monochorionic twin complications, management options, and the role for MRI in these pregnancies.

Fetal Skeletal Dysplasia.

Skeletal dysplasias (SDs) are a diverse group of genetic disorders. Diagnosis can be difficult as many are rare and with varied presentations, but with knowledge of the most common SDs presenting prenatal and with an algorithm that uses both sonographic and MR imaging techniques, directed genetic testing and counseling can be provided for many families.