Fetal Thymus Size at 19-22 Weeks of Gestation: A Possible Marker for the Prediction of Low Birth Weight?

INTRODUCTION: The purpose was to compare thymus size measured during second trimester screening of fetuses who were subsequently small for gestational age at birth (weight below 10th percentile, SGA group) with fetuses with normal birth weight (control group). We hypothesized that measuring the fetal thymic-thoracic ratio (TT-ratio) might help predict low birth weight. METHODS: Using three-vessel view echocardiograms from our archives, we measured the anteroposterior thymus size and the intrathoracic mediastinal diameter to derive TT-ratios in the SGA (n = 105) and control groups (n = 533) between 19+0 and 21+6 weeks of gestation. We analyzed the association between TT-ratio and SGA adjusted to the week of gestation using logistic regression. Finally, we determined the possible TT-ratio cut-off point for discrimination between SGA and control groups by means of receiver operating characteristics (ROC) curve analysis. RESULTS: The TT-ratio was significantly higher in the SGA group than in the control group (p < 0.001). An increase of the TT-ratio by 0.1 was associated with a 3.1-fold increase in the odds of diagnosing SGA. We determined that a possible discrimination cut-off point between SGA and healthy controls was achieved using a TT-ratio of 0.390 (area under the ROC curve 0.695). CONCLUSION: An increased TT-ratio may represent an additional prenatal screening parameter that improves the prediction of birth weight below the 10th percentile. Prospective studies are now needed to evaluate the use of fetal thymus size as predictive parameter for adverse fetal outcome.

Cervical strain elastography: pattern analysis and cervical sliding sign in preterm and control pregnancies.

OBJECTIVES: The aim of this study was to assess the value of cervical strain elastography and Cervical Sliding Sign (CSS) for predicting spontaneous preterm birth (sPTB). METHODS: In our case-control study we performed an elastographic assessment of the cervix in 82 cases of preterm birth (preterm group) and 451 control pregnancies (control group) between the 20th and 37th week of gestation. We divided the anterior cervical lip first into two ("Intern2", "Extern2") and into three sectors ("Intern3", "Middle3", "Extern3"). The tissue deformation pattern after local compression with an ultrasound probe was recorded. We distinguished between an irregularly distributed ("Spotting") and homogeneous pattern presentation. Additionally, the presence of a sliding of the anterior against the posterior cervical lip (positive CSS) during compression was evaluated. A logistic regression analysis and the Akaike Information Criterion (AIC) were used to estimate the probability of sPTB and to select a prediction model. RESULTS: Spotting and positive CSS occurred more frequently in the preterm group compared to control group (97.8 vs. 2.2%, p<0.001; 26.8 vs. 4.2%, p<0.001; respectively). The model with the parameters week of gestation at ultrasound examination, Intern3, Middle3 and CSS was calculated as the highest quality model for predicting sPTB. The AUC (Area Under the Curve) was higher for this parameter combination compared to cervical length (CL) (0.926 vs. 0.729). CONCLUSIONS: Cervical strain elastography pattern analysis may be useful for the prediction of sPTB, as the combination of Spotting analysis and CSS is superior to CL measurement alone.

Fetal adrenal gland size and umbilical artery Doppler in growth-restricted fetuses.

OBJECTIVES: In fetal growth restriction (FGR), Doppler ultrasound is the most important method for the detection and management. However, additional parameters are needed to improve the distinction between constitutionally small fetuses and fetuses affected by FGR. METHODS: A total of 445 singleton pregnancies between 23 and 40 weeks of gestation were included in our retrospective study, of which 67 with FGR and 378 normal fetuses. A 2D-plane of the fetal adrenal gland was obtained and the adrenal gland ratio was measured. Spearman's correlation coefficient was calculated to assess the association of fetal Doppler and adrenal gland ratio with outcome parameters. Logistic regression analysis was performed to assess the statistical significance of "PI of the umbilical artery" and "adrenal gland ratio" as prognostic factors for intrauterine growth restriction (IUGR). RESULTS: PI of the umbilical artery was shown to correlate with outcome parameters (WG_Delivery: r=-0.125, p=0.008; birth weight: r=-0.268, p<0.001; birth weight centile: r=-0.248, p<0.001; APGAR at 5 min: r=-0.117, p=0.014). Adrenal gland ratio showed no correlation with any of the outcome parameters. In logistic regression however, both PI of the umbilical artery and the adrenal ratio were shown to be significantly associated with fetal IUGR. When combining the two parameters, predictive value was superior to the predictive value of each individual parameter (AUC 0.738 [95% CI 0.670; 0.806]). CONCLUSIONS: The adrenal gland ratio can be a useful addition to Doppler ultrasound when it comes to the detection of fetal FGR. Prospective studies are needed to establish references ranges and cut-off values for clinical decision-making.

Congenital Limb Defects: A Retrospective Cohort Study and Overview of the Literature.

PURPOSE: Congenital limb defects are common malformations that are often associated with other organ defects and genetic disorders. Since prenatal detection is challenging and classification is often complex, the aim of this study was to describe a large cohort of fetuses with congenital limb defects and to identify characteristics that are essential for prenatal evaluation, counselling, and management. MATERIALS AND METHODS: In this retrospective cohort study, all cases of confirmed fetal limb defects from two centers for prenatal ultrasound between 2001 and 2021 were evaluated. Cases with skeletal dysplasia were excluded from this study. Demographic data, association with genetic disorders, and correlation with maternal parameters were analyzed statistically. RESULTS: 170 fetuses were included in this study. 60% were diagnosed with a reduction anomaly and 40% with a duplication anomaly. The majority of fetuses were male, and in 73.5% of all cases, additional malformations were present. Among the genetic causes, trisomy 13 and 18 were the most common in this cohort. CONCLUSION: Congenital limb malformations are important markers for complex fetal disorders that warrant referral to specialists in prenatal ultrasound. To improve prenatal detection, care should be taken to visualize all fetal extremities already in early pregnancy.

Periodontal disease in pregnancy: A comparative prospective study.

INTRODUCTION: Periodontal disease affects many pregnant women and may be associated with adverse pregnancy outcomes. The object of this study was to evaluate women's level of knowledge about this condition in pregnancy. We compared level of knowledge, participation in medical screening, and periodontal health status in pregnant women and nonpregnant controls. MATERIAL AND METHODS: This study included 141 pregnant and 141 nonpregnant women, examined by one examiner at the Department of Gynecology and Obstetrics of the University Hospital Muenster, Germany. With reference to periodontal health status, the Periodontal Screening Index was used and a questionnaire was designed to represent the level of knowledge and predisposing factors. RESULTS: Pregnant women showed a strong tendency towards higher Periodontal Screening Indices than the nonpregnant controls (P=0.058). A strong positive correlation between participation in screenings and a lower Periodontal Screening Index was measured, but no direct relation between knowledge and periodontal health was detected. However, a better level of knowledge correlated noticeably with participation in screening programs. Educational attainment was found to be a main factor correlated with periodontal health and further factors such as medical screening and smoking habits. A great number of women felt they were not sufficiently informed about oral health aspects in pregnancy. CONCLUSIONS: As participation in screenings was a main item that positively correlated with healthier periodontal status, it had to be a focused element. The possible positive influence of knowledge regarding the participation in screening programs showed not only the need to spread awareness but also the need for proper education.

Termination of pregnancy in the second trimester - the course of different therapy regimens.

OBJECTIVES: To compare two prostaglandin analogs and two application intervals between mifepristone and the prostaglandin analog administration on the time to abortion in second trimester termination of pregnancy. Other endpoints were live birth rate and fetal lifetime after expulsion. METHODS: Retrospective data of 373 abortions performed were evaluated. Four medical induction subgroups and two feticide subgroups were considered. The definition criteria of the subgroups were the choice of administered prostaglandin analog (misoprostol vs. sulprostone) and the time interval between mifepristone and prostaglandin analog administration (48 vs. 24 h). The outcome parameters were the time to complete uterine evacuation (TCUE), the live birth rate and duration of fetal life. RESULTS: In the misoprostol subgroups, the median TCUE was 1.6 h longer in the 24-h group than in the 48-h group (p=0.950). In the sulprostone subgroups, the median TCUE was 1.9 h shorter in the 24-h group than in the 48-h group (p=0.950). The median TCUE was shorter for sulprostone than for misoprostol in all six subgroups (p<0.001). The rate of fetal live births ranged between 13.6 and 15.9% within the medical induction subgroups (p=0.969). The median fetal lifetime was slightly shorter in the sulprostone groups than in the misoprostol groups (p=0.563). CONCLUSIONS: Both application intervals and prostaglandin analogs are similarly effective. The therapy regime should be adapted to the personal preferences of the woman, the situational and clinical conditions.

Importance of frame rate for the measurement of strain and synchrony in fetuses using speckle tracking echocardiography.

OBJECTIVES: To assess the influence of frame rate settings on longitudinal strain (LS) and mechanical synchrony (SYN) values in Speckle Tracking Echocardiography (STE) of healthy fetuses. METHODS: In this prospective study, we collected transversal or apical four-chamber-views of 121 healthy fetuses between 20 and 38 weeks of gestation using three different frame rate (FR) settings (≥ 110, 100 ± 10, 60 ± 10 frames per second). We assessed the segmental and the global LS of both ventricles (2C) and of the left ventricle (LV) offline with QLab 10.8 (Philips Medical Systems, Andover, MA, USA). Inter- and intraventricular SYN were calculated as time difference in peak myocardial strain between the mid-segments of left and right ventricle (interventricular, 2C_Syn) and lateral wall and septum of the left ventricle (intraventricular, LV_Syn), respectively. RESULTS: In 84.3% STE was feasible at all three FR settings. The LS increased in both views at higher FRs to a statistically noticeable extent. SYN measurements and the absolute differences at patient level between the FR settings showed no statistically noticeable alterations. CONCLUSIONS: STE is feasible at low and high FR settings. SYN emerges to be a robust parameter for fetal STE as it is less affected by the FR. High FRs enable high temporal resolutions and thus an accurate examination of fetal hearts. Future research for the technical implementation of tailored fetal STE software is necessary for reliable clinical application.

Central nervous system biometry in fetuses with and without congenital heart diseases.

OBJECTIVE: To compare the fetal brain structures assessed in routine sonographic scans during the second and third trimesters in fetuses with and without congenital heart disease (CHD). METHODS: This is a retrospective cross-sectional single-center study. We measured the head circumference (HC), the transversal diameter of the cerebellum (TCD) and the sizes of the cisterna magna (CM), the cavum septi pellucidi (CSP) and the posterior ventricles (PV) between 20 and 41 weeks of gestation. We compared 160 fetuses with CHD (case group) to 160 fetuses of normal pregnancies (control group). Every patient was matched with a control, considering the gestational age at which the ultrasound was performed. We divided the CHD group into 3 subgroups: retrograde flow in the aortic arch (group 1), right heart anomaly with the antegrade flow in the aortic arch (group 2) and other CHDs with the antegrade flow in the aortic arch (group 3). RESULTS: The mean width of the PV was larger in fetuses of groups 1 and 3 in comparison to the control group (P < 0.001, P = 0.022; respectively). We found that the APGAR score at 5 min (P < 0.001, P < 0.001; respectively) and gestational age at delivery (P = 0.006, P = 0.001; respectively) were inferior in groups 1 and 3 compared to controls. CONCLUSIONS: Central nervous system biometry is altered in fetuses with CHD. PV is enlarged in CHD fetuses especially with decreased oxygen levels in the aortic arch.

Update Reference Charts: Fetal Biometry between the 15th and 42nd Week of Gestation.

OBJECTIVES: This study was designed to establish new reference charts for BPD (biparietal diameter), OFD (occipitofrontal diameter), HC (head circumference), CM (cisterna magna), TCD (transverse cerebellar diameter), PCV (posterior cerebral ventricle), AC (abdominal circumference), FL (femur length), and HL (humerus length) and extend known charts to 42 weeks of gestation. These new charts were compared to studies carried out by Snijders and Nicolaides, the INTERGROWTH 21st Project, and the WHO Fetal Growth Charts. METHODS: In this retrospective cross-sectional single-center study of 12,972 low-risk pregnancies, biometric data between the 15th and 42nd weeks of gestation were evaluated. Only one examination per pregnancy was selected for statistical analysis. Descriptive analysis for the 5th, 50th, and 95th quantile was performed for each parameter as listed above. Regression models were used to fit the mean and the SD at each gestational age. RESULTS: Initially the reference curves for BPD, OFD, HC, AC, FL, and HL show a linear increase, which changes into a cubic increase towards the end of pregnancy. The results of this study show statistically noticeable differences from the percentile curves of the studies listed above. CONCLUSIONS: The percentile curves in this study differ from the commonly used ones. The presented standard curves can be used as a reference in prenatal diagnostics.

Correlation of first-trimester thymus size with chromosomal anomalies.

OBJECTIVES: The aim of this study was to investigate the correlation between fetal thymus size measured during first-trimester screening and chromosomal anomalies. METHODS: This study is a retrospective evaluation, in which the anterior-posterior diameter of the thymus in a midsagittal plane was measured in first-trimester ultrasound between 11+0 and 13+6 weeks of gestation in 168 fetuses with chromosomal anomalies (study group) and 593 healthy fetuses (control group). The included cases were subdivided into six groups: (1) trisomy 21, (2) trisomy 18, (3) trisomy 13, (4) Turner syndrome, (5) triploidy and (6) normal controls. Thymus size measurements were adjusted to the week of gestation, which was determined by ultrasound using crown-rump-length (CRL), by calculating a ratio between CRL and thymus size (CRL-thymus-ratio). Each study group was compared with the control group separately. RESULTS: Thymus size in fetuses affected by trisomy 18 or trisomy 13 was noticeably smaller compared to the control group (1.4 mm [1.3, 1.5] and 1.3 mm [1.2, 1.4] vs. 1.8 mm [1.6, 2.1]; all p<0.001; respectively). The thymus size of fetuses with trisomy 21 and Turner syndrome did not differ from healthy fetuses. Between the CRL-thymus-ratios of the separate study groups no statistically noticeable differences could be found. CONCLUSIONS: Fetal thymus size appeared to be smaller in pregnancies affected by trisomy 18 and trisomy 13. The predictive value of fetal thymus size in first-trimester screening should be evaluated prospectively.

Cervical elastography strain ratio and strain pattern for the prediction of a successful induction of labour.

OBJECTIVES: The aim of this study was to introduce cervical strain elastography to objectively assess the cervical tissue transformation process during induction of labour (IOL) and to evaluate the potential of cervical elastography as a predictor of successful IOL. METHODS: A total of 41 patients with full-term pregnancies elected for an IOL were included. Vaginal ultrasound with measurement of cervical length and elastography and assessment of the Bishop Score were performed before and 3 h after IOL. The measured parameters were correlated to the outcome of IOL and the time until delivery. RESULTS: We observed an association between the strain pattern and the value of the strain ratio 3 h after IOL and a successful IOL (p=0.0343 and p=0.0342, respectively) which can be well demonstrated by the results after 48 h. In our study population the cervical length and the Bishop Score did not prove to be relevant parameters for the prediction of a successful IOL. CONCLUSIONS: We demonstrated for the first time that the cervical elastography pattern after the first prostaglandine application can help predict the outcome of IOL.

Comparison of strain and dyssynchrony measurements in fetal two-dimensional speckle tracking echocardiography using Philips and TomTec.

Background The aim of this study was to compare Philips and TomTec two-dimensional speckle tracking echocardiography (2D-STE) software measurements of strain and dyssynchrony values in healthy fetuses. Methods This was an explorative observational study in which the echocardiographic data of 93 healthy fetuses between the 20th and 38th week of gestation were determined from a four-chamber view using 2D speckle tracking. The global and segmental longitudinal strain values of both ventricles, inter-ventricular and left intra-ventricular dyssynchrony were analyzed using QLab version 10.8 (Philips Medical Systems, Andover, MA, USA) and TomTec-Arena version 2.30 (TomTec, Unterschleißheim, Germany). Results TomTec showed persistently lower values for all of the assessed strain and dyssynchrony variables. For all variables, the bias between vendors tended to increase with gestational age, though not to a significant extent. Left ventricular dyssynchrony and longitudinal strain within the mid segment of the septum correlated best between vendors; however, the limits of agreement were wide in both cases. None of the variables assessed in the two-chamber view compared well between QLAB and TomTec. Conclusion Speckle tracking software cannot be used interchangeably between vendors. Further investigations are necessary to standardize fetal 2D-STE.

Fetal brain development in small-for-gestational age (SGA) fetuses and normal controls.

Objective To assess whether fetal brain structures routinely measured during the second and third trimester ultrasound scans, particularly the width of the cavum septi pellucidi (CSP), differ between fetuses small for gestational age (SGA), fetuses very small for gestational age (VSGA) and normal controls. Methods In this retrospective study, we examined standard ultrasound measurements of 116 VSGA, 131 SGA fetuses and 136 normal controls including the head circumference (HC), transversal diameter of the cerebellum (TCD), the sizes of the lateral ventricle (LV) and the cisterna magna (CM) from the second and third trimester ultrasound scans extracted from a clinical database. We measured the CSP in these archived ultrasound scans. The HC/CSP, HC/LV, HC/CM and HC/TCD ratios were calculated as relative values independent of the fetal size. Results The HC/CSP ratio differed notably between the controls and each of the other groups (VSGA P = 0.018 and SGA P = 0.017). No notable difference in the HC/CSP ratio between the VSGA and SGA groups could be found (P = 0.960). The HC/LV, HC/CM and HC/TCD ratios were similar in all the three groups. Conclusion Relative to HC, the CSP is larger in VSGA and SGA fetuses than in normal controls. However, there is no notable difference between VSGA and SGA fetuses, which might be an indicator for abnormal brain development in this group.

Evaluation of Cervical Elastography Strain Pattern to Predict Preterm Birth.

PURPOSE: To evaluate cervical elastography strain pattern as a predictive marker for spontaneous preterm delivery (SPTD). MATERIALS AND METHODS: In this case-control study cervical length (CL) and elastographic data (strain ratio, elastography index, strain pattern score) were acquired from 335 pregnant women (20th - 34th week of gestation) by transvaginal ultrasound. Data of 50 preterm deliveries were compared with 285 normal controls. Strain ratio and elastography index were calculated by placing two regions of interest (ROIs) in parallel on the anterior cervical lip. The strain ratio was determined by dividing the higher strain value by the lower one. The elastography index was defined as the maximum of the strain ratio curve. Elastographic images were assigned a new established strain pattern (SP) score between 0 and 2 according to the distribution of strain induced by compression. RESULTS: Elastography index, SP score and CL differed between preterm and normal pregnancies (1.61 vs. 1.27, p < 0.001; SP score value of "2": n = 31 (62 %) vs. n = 36 (12.6 %), p < 0.001; CL 30.7 vs. 41.0 mm, p < 0.001; respectively). The elastography index and SP score were associated with a higher predictive potential than CL measurement alone (AUC 0.8059 (area under the curve); AUC 0.7716; AUC 0.7631; respectively). A combination of all parameters proved more predictive than any single parameter (AUC 0.8987; respectively). CONCLUSION: Higher elastography index and SP scores were correlated with an elevated risk of SPTD and are superior to CL measurement as a predictive marker. A combination of these parameters could be used as a "Cervical Index" for the prediction of SPTD.

New Method for Assessment of Levator Avulsion Injury: A Comparative Elastography Study.

OBJECTIVE: The aim of this study was to introduce elastography as a new method for sonographic assessment of postpartum pelvic floor trauma. METHODS: We examined 86 postpartum primiparous women, of whom 43 had undergone primary caesarean section (group_CS) and 43 vaginal delivery (group_VD). In a puborectal-symphysis plane, B-mode and elastographic ultrasonography were used to evaluate pelvic floor trauma. The strain value of left and right puborectal muscle was assessed close to the symphysis (Trauma_Elastography). The strain ratio maximum of this measurement was stored (Trauma_Index). RESULTS: The elastographic evaluation revealed more trauma-suspicious lesions than the B-mode investigation (60.5% versus 39.5%; P < .001). The median Trauma_Index was higher in group_VD compared to group_CS (1.63 versus 1.18; P < .001). CONCLUSION: Sonographic elastography assessment in a new examination plane shows postpartum trauma of the pelvic floor in women after vaginal delivery. This new method may help to identify women with a higher risk of postpartum pelvic floor disorders.

Fetal adrenal gland size in gestational diabetes mellitus.

Background The aim of this study was to compare the adrenal gland size of fetuses of women with gestational diabetes mellitus (GDM) with that of healthy control fetuses. Methods This prospective cross-sectional study included measurements of the adrenal gland size of 62 GDM fetuses (GDM group) and 370 normal controls (control group) between the 19th and 41st week of gestation. A standardized transversal plane was used to measure the total width and the medulla width. The cortex width and an adrenal gland ratio (total width/medulla width) were calculated from these data. Adrenal gland size measurements were adjusted to the week of gestation and compared between the two groups in a multivariable linear regression analysis. A variance decomposition metric was used to compare the relative importance of predictors of the different adrenal gland size measurements. Results For all the investigated parameters of the adrenal gland size, increased values were found in the case of GDM (P < 0.05), while adjusting for the week of gestation. GDM seems to have a greater impact on the size of the cortex than on the size of the medulla. Conclusion The fetal adrenal gland is enlarged in pregnancy complicated by GDM. The width of the cortex seems to be particularly affected.

Procedure related risk of premature delivery and fetal growth reduction following amniocentesis, transcervical and transabdominal chorionic villus sampling: a retrospective study.

Background The aim of this study was to compare transabdominal and transcervical chorionic villus sampling (CVS) as well as amniocentesis (AC) with respect to their rates of premature delivery and fetal growth restriction. Methods We retrospectively evaluated the mentioned procedures of invasive prenatal testing performed in a single center between 2001 and 2016. Seven hundred and ninety-nine cases of AC and 719 cases of CVS were included, of which 400 were performed transvaginally. Only singleton pregnancies with a normal karyotype and delivery after 24 + 0 weeks of gestation were included. Fetal growth restriction was defined as birth weight below the 10th percentile. Premature delivery was defined as delivery before 37 + 0 weeks of gestation. Data were compared to a control group without an invasive procedure. Results The frequency of premature delivery was 8.5% after transabdominal CVS, 6.3% after transcervical CVS and 10.5% after AC as compared to 10.8% in the control group. The frequency of fetal growth restriction was 8.2% after transabdominal CVS 6.8% after transcervical CVS and 8.4% after AC as compared to 9.7% in the control group. Conclusion Our study supports that the three different methods of invasive prenatal testing do not lead to a higher risk of either premature delivery or fetal growth restriction when compared to controls. We found no difference in risk profile among the three techniques.

Influence of maternal HIV infection on fetal thymus size.

Objective To reveal the effect of a maternal human immunodeficiency virus (HIV) infection on the fetal thymus size. Methods The sonographic fetal thymus size was measured retrospectively in 105 pregnancies with maternal HIV infection and in 615 uncomplicated singleton pregnancies. The anteroposterior thymic and the intrathoracic mediastinal diameter were determined in the three-vessel view and their quotient, the thymic-thoracic ratio (TT ratio), was calculated. The study group was subdivided into three groups by the maternal viral load on the date of ultrasound (<50 cop./mL, 50-1000 cop./mL, >1000 cop./mL). Furthermore, an association between prognostic factors of the HIV infection such as the lymphocyte count, CD4/CD8 ratio, HIV medication and the thymus size, was investigated using correlation analyses. Results Fetal thymus size in pregnancies of HIV-positive mothers showed to be noticeably larger than in uncomplicated pregnancies. The mean TT ratio in the HIV-positive group was 0.389 and in the control group 0.345 (P < 0.001). There was no association between any maternal HIV parameter or medication and the size of the thymus gland. Conclusion Maternal HIV infection was associated with an increased fetal thymus size. Further consequences of intrauterine HIV exposure for fetal outcome and the development of the immune system of HIV-exposed uninfected (HEU) infants must be discussed.

Strain and dyssynchrony in fetuses with congenital heart disease compared to normal controls using speckle tracking echocardiography (STE).

Objective To compare myocardial strain and mechanical dyssynchrony in fetuses with congenital heart disease (CHD) to normal controls using speckle tracking echocardiography (STE). Methods In this comparative cross-sectional study 23 fetuses with CHD and 105 normal controls between 19 and 41 weeks of gestation were assessed with STE. The STE sample box was placed over the myocardium of both ventricles. The parameters of interest included the segmental strain of the left (LV-S) and right lateral ventricle wall (RV-S) and the global ventricular strain of both chambers (2C-S). In order to separately assess the LV, we placed the STE sample box over the myocardium of the LV. We calculated the strain of the LV lateral wall (LW-S), the septum (SEPT-S) and the global ventricular strain of the single LV (1C-S). Furthermore, we analyzed the differences in timing of negative peak myocardial strain between the LV and RV (two-chamber dyssynchrony, 2C-DYS) and also within the LV between the lateral wall and the septum (one-chamber dyssynchrony, 1C-DYS). Results The evaluation of strain and mechanical dyssynchrony was feasible in all cases. Compared to normal controls, fetuses with CHD showed lower segmental and global strain values and the extent of 2C-DYS and 1C-DYS was higher than in the healthy control group. Conclusion The deterioration of myocardial function in CHD can be measured with STE. The assessment of strain and dyssynchrony with STE may be useful for distinguishing fetuses with CHD from healthy fetuses.

3D Ultrasound Evaluation of the Fetal Outer Ear: Novel Biometry Ratio and Comparison of Different Surface Display Modes.

BACKGROUND: The examination of the fetal ear is a promising but still challenging approach in prenatal diagnosis. OBJECTIVES: This study investigated a novel ear length/width ratio based on anatomical landmarks. Additionally, we compared different 3D ultrasound surface rendering modes regarding their potential to depict detailed structures of the outer ear. METHOD: We measured both the ear length and width of 118 fetal ears from 20 to 40 weeks of gestation to establish a length/width ratio. Additionally, we rendered the volumes in three different surface display modes and one adapted light position. Each image was scored regarding the visibility of distinct structures of the ear relief and indicator scores were evaluated for each mode. RESULTS: The median of the length/width ratio was 1.9 with a slight decline over the gestational period. The overall visibility of the ear structures differed noticeably between the four surface display modes (p < 0.001). The post hoc comparison showed that the display mode "TrueVue" resulted in the highest indicator scores. CONCLUSION: The length/width ratio based on anatomical landmarks of the ear could prospectively be used as a marker in syndrome detection. The study showed a superiority of the surface display mode "TrueVue" for examination of the detailed ear structures.