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1.
Dynamis (Granada) ; 43(2): 459-485, 2023. ilus
Article in Spanish | IBECS | ID: ibc-229575

ABSTRACT

Este texto presenta una propuesta de cronología de imágenes fetales en España, que incluye el proceso de producción y circulación de representaciones de cromosomas humanos —el cariotipo como retrato—, de las fotografías hechas y publicadas por el fotógrafo sueco Lennart Nilsson y de las figuras obtenidas por ecografía. Este conjunto de representaciones construyó la cultura visual del feto como una ontología híbrida que tomó la forma de sujeto histórico de género. Esa manufactura medicalizó y tecnificó el embarazo, privilegió al embrión y al feto y restó protagonismo al cuerpo de las mujeres. El trabajo se suma a la historiografía sobre la centralidad del feto, que se analiza aquí como producto de la interacción entre tres tecnologías: la citológica, la fotográfica y la ecográfica. (AU)


This article presents a proposal for a chronology of fetal images in Spain that includes the process of production and circulation of human chromosomes (fetal karyotype as a portrait), of the photographs of fetuses by Lennart Nilsson, and of the images provided by ultrasound scanning. This set of representations made the visual culture of the fetus a gendered historical subject that medicalized and technified pregnancy, privileging the fetus instead of the woman’s pregnant body as the subject of pregnancy. In this process, the fetus gained autonomy as a hybrid ontology. This article contributes to a fetal historiography that analyzes the fetus as manufactured by the interaction of three technologies: cytology, photography, and ultrasound scanning. (AU)


Subject(s)
Humans , Female , Pregnancy , Historiography , Ultrasonography, Prenatal/history , Ultrasonography, Prenatal/instrumentation , Fetal Monitoring/history , Spain
2.
BMC Pregnancy Childbirth ; 22(1): 196, 2022 Mar 10.
Article in English | MEDLINE | ID: mdl-35272631

ABSTRACT

BACKGROUND: Ethiopia is a low-income country located in the horn of Africa's sub-Saharan region, with very high incidences of maternal and neonatal mortality. Quality antenatal care improves perinatal health outcomes. The USAID funded Transform: Primary Health Care Activity in collaboration with the Ministry of Health and GE Healthcare introduced Vscan limited obstetric ultrasound services in 120 health centers in Ethiopia. So far, the experiences and opinions of midwives on their use have not been explored and described within the local context. This study therefore aims to explore and describe the experiences and opinions of midwives on Vscan limited obstetric ultrasound services at health centers within Ethiopia. METHODS: An exploratory and descriptive qualitative study was conducted in Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia. Twenty-four participants were selected through a purposeful sampling technique. In-depth individual interviews with trained midwives with practical hands-on limited obstetric ultrasound service provision experience were conducted. The thematic analysis was conducted manually. RESULTS: The qualitative data analysis on the experiences and opinions of midwives revealed three themes, namely: individual perception of self-efficacy, facilitators, and barriers of limited obstetric ultrasound services. The basic ultrasound training, which was unique in its organization and arrangement, prepared and built the self-efficacy of trainees in executing their expected competencies. Support of health systems and health managers in dedicating space, availing essential supplies, and assigning human resources emerged as facilitators of the initiated limited obstetric ultrasound services, whereas high workload on one or two ultrasound trained midwives, interruption of essential supplies like paper towels, gel, and alternative power sources were identified as barriers for limited ultrasound services. CONCLUSION: This study explored the experiences and opinions of midwives who were trained on the provision of limited obstetric ultrasound services and served the community in health centers in rural parts of Ethiopia. The results of this study revealed the positive impacts of the intervention on the perceived self-efficacy, facilitation, and breaking-down of barriers to obstetric ultrasound services. Before scaling-up limited obstetric ultrasound interventions, health managers should ensure and commit to availing essential supplies (e.g., paper towels, ultrasound gel, and large memory hard discs), arranging private rooms, and training other mid-level health professionals. In addition, improving pregnant women's literacy on the national schedule for ultrasound scanning services is recommended.


Subject(s)
Attitude of Health Personnel , Midwifery/education , Prenatal Care/methods , Ultrasonography, Prenatal/instrumentation , Adult , Community Health Centers , Ethiopia , Female , Humans , Male , Qualitative Research , Rural Population
3.
Prenat Diagn ; 42(1): 49-59, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34648206

ABSTRACT

OBJECTIVE: Advances in artificial intelligence (AI) have demonstrated potential to improve medical diagnosis. We piloted the end-to-end automation of the mid-trimester screening ultrasound scan using AI-enabled tools. METHODS: A prospective method comparison study was conducted. Participants had both standard and AI-assisted US scans performed. The AI tools automated image acquisition, biometric measurement, and report production. A feedback survey captured the sonographers' perceptions of scanning. RESULTS: Twenty-three subjects were studied. The average time saving per scan was 7.62 min (34.7%) with the AI-assisted method (p < 0.0001). There was no difference in reporting time. There were no clinically significant differences in biometric measurements between the two methods. The AI tools saved a satisfactory view in 93% of the cases (four core views only), and 73% for the full 13 views, compared to 98% for both using the manual scan. Survey responses suggest that the AI tools helped sonographers to concentrate on image interpretation by removing disruptive tasks. CONCLUSION: Separating freehand scanning from image capture and measurement resulted in a faster scan and altered workflow. Removing repetitive tasks may allow more attention to be directed identifying fetal malformation. Further work is required to improve the image plane detection algorithm for use in real time.


Subject(s)
Artificial Intelligence/standards , Congenital Abnormalities/diagnosis , Ultrasonography, Prenatal/instrumentation , Adult , Artificial Intelligence/trends , Congenital Abnormalities/diagnostic imaging , Female , Gestational Age , Humans , Pregnancy , Prospective Studies , Reproducibility of Results , Ultrasonography, Prenatal/methods , Ultrasonography, Prenatal/standards
5.
J Perinat Med ; 48(9): 931-942, 2020 Nov 26.
Article in English | MEDLINE | ID: mdl-32681782

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated infection (COVID-19) is affecting populations worldwide. This statement may serve as guidance for infection prevention and safe ultrasound practices during the COVID-19 pandemic. Ultrasound examination is a fundamental part of obstetric care, yet it is a potential vector for transmission of SARS-CoV-2. Decontamination methods should always be implemented for ultrasound equipment, especially in the presence of suspected or confirmed COVID-19 cases. There must be workflow policies to protect pregnant women and healthcare providers from nosocomial cross transmission of SARS-CoV-2. Cleaning and disinfecting of equipment must be in accordance with their potential of pathogen transmission. Consider using telemedicine and genetic technologies as an adjunctive of obstetric ultrasound to reduce patient crowding. Patient triage and education of healthcare providers of infection prevention are crucial to minimize cross contamination of SARS-CoV-2 during obstetric ultrasound.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Equipment Contamination/prevention & control , Pneumonia, Viral/transmission , Pregnancy Complications, Infectious/virology , Ultrasonography, Prenatal/instrumentation , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Disinfection/methods , Female , Health Personnel/education , Humans , Hygiene , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2
6.
Am J Obstet Gynecol ; 223(3): B2-B6, 2020 09.
Article in English | MEDLINE | ID: mdl-32470457

ABSTRACT

Recent surveys have shown widespread lapses in the procedures used to reduce the risk of transmitting infection via medical devices. Transvaginal ultrasound examination has the potential to transmit vaginal infections, including human papillomavirus. Areas of particular concern are the use of probe covers with high rates of leakage, disinfectants that are not effective against human papillomavirus, and coupling gel from multiple-use containers. We reviewed these issues, and we recommend 4 steps to reduce the risk of transmitting infection. First, during every transvaginal ultrasound exam, the probe should be covered with a sterile, single-use "viral barrier" cover or a condom. Second, sterile, single-use ultrasound gel packets should be used. Third, after every examination, the probe should be cleaned to remove any visible gel or debris. Finally, after cleaning, the probe should undergo high-level disinfection using an agent with proven efficacy against the human papillomavirus, including hydrogen peroxide, hypochlorite, or peracetic acid. Glutaraldehyde, orthophthalaldehyde, phenols, and isopropyl alcohol have virtually no efficacy against the human papillomavirus.


Subject(s)
Disease Transmission, Infectious/prevention & control , Equipment Contamination/prevention & control , Ultrasonography, Prenatal/instrumentation , Vaginal Diseases/microbiology , Vaginal Diseases/prevention & control , Disinfectants , Disinfection/methods , Disposable Equipment , Female , Glutaral , Humans , Infection Control/methods , Papillomavirus Infections/prevention & control , Pregnancy , Sterilization/methods , Ultrasonography, Prenatal/adverse effects , Vaginal Diseases/virology , o-Phthalaldehyde
7.
Article in Spanish | IBECS | ID: ibc-191747

ABSTRACT

En situación de pandemia, los tres principios básicos en la atención sanitaria son priorizar los recursos, mantener el confinamiento del paciente para evitar la transmisión comunitaria y el colapso sanitario, y reducir la asistencia no prioritaria con el fin de evitar la exposición del paciente y de salvaguardar la salud del profesional sanitario. El control antenatal debe mantenerse durante el periodo de crisis sanitaria, independientemente del estado de alerta COVID-19. La ecografía obstétrica es una prueba fundamental para la toma de decisiones clínicas durante el embarazo, con un impacto en el manejo del binomio madre-feto y en el resultado perinatal, por lo que se ha de garantizar su realización. Con el fin de reducir las visitas presenciales al mínimo número posible, estas se intentarán organizar teniendo en cuenta los controles ecográficos establecidos. Basados en la evidencia científica y en las principales guías nacionales e internacionales, hemos elaborado este documento que incluye las principales recomendaciones para el cuidado antenatal de la gestante en el contexto de la pandemia por SARS-CoV-2. En él se recoge cómo debe reestructurarse una Sección de Medicina Fetal ante esta nueva situación, qué medidas de seguridad deben seguirse para la realización de las exploraciones ecográficas y técnicas invasivas, y de qué modo debe procederse para la limpieza y desinfección de los equipos ecográficos. Estas recomendaciones deberán adaptarse a los diferentes medios teniendo en cuenta la infraestructura del centro y sus recursos


During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients’ lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure


Subject(s)
Humans , Pandemics/prevention & control , Coronavirus Infections/prevention & control , Pneumonia, Viral/prevention & control , Equipment Safety/methods , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Ultrasonography, Prenatal/instrumentation , Disinfection
8.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 122-126, jul.-sept. 2019. ilus, tab
Article in Spanish | IBECS | ID: ibc-182718

ABSTRACT

El embarazo es un estado donde se aumenta la litogenicidad y la estasis biliar, generando mayor incidencia en la formación de cálculos biliares. Aunque la colelitiasis por sí sola no es una urgencia quirúrgica en la paciente obstétrica, puede requerir de intervención si se presentan complicaciones, las cuales se dan hasta en un 10% de las pacientes obstétricas con colelitiasis sintomática. En este artículo se presentará un caso clínico de una paciente obstétrica que presentó colelitiasis con coledocolitiasis de alto riesgo que requirió manejo con colangiopancreatografía retrógrada endoscópica


Lithogenesis and biliary stasis increases during pregnancy. This generates a high incidence in the production of gallstones. Cholelithiasis is not usually a surgical emergency in pregnancy, but when there are complications, which can be in up to 10% of obstetric patients, these complications can require intervention. A case report is presented on an obstetric patient with cholelithiasis, and high risk of choledocholithiasis, that required intervention using endoscopic retrograde cholangiopancreatography


Subject(s)
Humans , Female , Pregnancy , Adult , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/therapy , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholelithiasis/diagnostic imaging , Cholelithiasis/therapy , Obstetric Labor, Premature , Acetaminophen , Betamethasone/administration & dosage , Proteinuria/urine , Bile Ducts/diagnostic imaging , Hyperbilirubinemia/diagnosis , Sphincterotomy/instrumentation , Ultrasonography, Prenatal/instrumentation
9.
J Am Soc Echocardiogr ; 32(10): 1339-1349.e23, 2019 10.
Article in English | MEDLINE | ID: mdl-31351791

ABSTRACT

BACKGROUND: Fetal and neonatal studies report a wide range of cardiac parameters derived by pulsed-wave Doppler tissue imaging (DTI) and two-dimensional speckle-tracking echocardiographic (STE) imaging. The use of different ultrasound systems and their vendor-specific software compromises the ability to compare echocardiographic findings among various studies. The aim of this study was to evaluate intervendor reproducibility as well as intra- and interobserver repeatability of DTI and STE measurements in normal-term fetuses and neonates. METHODS: A prospective study was conducted of term fetuses (n = 196) from uncomplicated pregnancies assessed days before the onset of labor and a few hours after birth. Fetal and neonatal DTI and STE parameters were obtained and analyzed using vendor-specific software on three ultrasound systems: Toshiba Aplio MX versus GE Vivid E9 and GE Vivid E9 versus Philips EPIQ. A reproducibility study in fetuses and neonates (n = 118) was performed by systematic scanning with head-to-head comparison. RESULTS: DTI reproducibility showed moderate to good correlation, with good agreement for fetuses and neonates on Toshiba versus GE (intraclass correlation coefficient [ICC] = 0.4-0.8). Correlation of DTI measurements on GE versus Philips was poor to moderate for fetuses (ICC = 0.1-0.6) and moderate to good for neonates (ICC = 0.5-0.8), with wider limits of agreement. Fetal and neonatal STE parameters revealed very poor correlation (ICC = 0.1-0.3) and agreement among ultrasound vendors. Intra- and interobserver repeatability demonstrated good to excellent correlation of all fetal and neonatal DTI and STE measurements, with good agreement irrespective of the ultrasound platform used. CONCLUSIONS: These findings demonstrate reliable assessment of fetal and neonatal DTI and STE measurements when performed on the same ultrasound platform, whereas ultrasound machines and software from different vendors give significantly divergent estimates of DTI and STE parameters in fetuses and neonates. These intervendor discrepancies have significant clinical and research implications and should be considered when interpreting and comparing study findings, establishing reference standards, or performing systematic reviews.


Subject(s)
Echocardiography, Doppler/instrumentation , Heart Defects, Congenital/diagnostic imaging , Ultrasonography, Prenatal/instrumentation , Adult , Female , Humans , Infant, Newborn , Longitudinal Studies , Observer Variation , Pregnancy , Prospective Studies , Reproducibility of Results
10.
J Perinat Med ; 47(6): 592-597, 2019 Aug 27.
Article in English | MEDLINE | ID: mdl-31141491

ABSTRACT

Objective To understand the impact of the measurement method to predict actual birthweight in pregnancies complicated with isolated polyhydramnios in the third trimester. Methods A prospective study was conducted with 60 pregnant women between the 37th and 40th weeks of gestation. Routine biometric measurements were obtained by two-dimensional (2D) ultrasonography. When a satisfactory image was obtained, the image was frozen to get two measurements. First, calipers were placed to get the manual measurement. Then automated measurement was captured by the ultrasonography machine in the same image. The fetal weight was estimated by using the Hadlock II formula. Results The mean difference was found to be 0.03, -0.77, -0.02 and 0.17 for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), respectively. Pearson's correlation coefficient between automated and manual estimated fetal weights (EFWs) and the actual birthweight was 0.919 and 0.796, respectively. The mean difference between actual and manual EFW measurement values was 46.16 ± 363.81 g (range between -745 g and 685 g) (P = 0.330). Also, the mean difference between actual and automated EFW measurement values was found to be 31.98 ± 218.65 g (range between -378 g and 742 g) (P = 0.262). The Bland-Altman test results have shown that, 666 g lower or 759 g higher values were obtained when the measurement was performed manually. On the other hand, EFW results were 396 g lower or 460 g higher than the actual birthweight with automated measurement tools. Conclusion The accuracy rate of fetal weight estimation with ultrasonography is high for both automated and manual measurements. Automated tools have a higher success to predict the EFW.


Subject(s)
Birth Weight , Body Weights and Measures/methods , Fetal Weight , Polyhydramnios/diagnosis , Prenatal Diagnosis/methods , Ultrasonography, Prenatal , Adult , Comparative Effectiveness Research , Dimensional Measurement Accuracy , Female , Gestational Age , Humans , Image Processing, Computer-Assisted/methods , Pregnancy , Pregnancy Trimester, Third , Ultrasonography, Prenatal/instrumentation , Ultrasonography, Prenatal/methods
11.
Prenat Diagn ; 39(4): 303-307, 2019 03.
Article in English | MEDLINE | ID: mdl-30698846

ABSTRACT

OBJECTIVE: The "Fetal Brain Tutor 4us" (FBTApp) is a recently developed application for interactive multiplanar navigation through the normal fetal brain. The purpose of this work was to assess its impact on normal anatomy learning. METHODS: A multiple-choice quiz (MCQ) was administered to first-year resident doctors in Obstetrics and Gynecology in two separate sessions, before and 2 weeks after downloading the FBTApp. For each MCQ, the junior trainee was asked to use one out of five items to label a specific cerebral structure on an ultrasound image of a normal midtrimester fetal brain. Six sonographic images of the fetal brain on each of the three scanning planes (axial, sagittal, and coronal) were shown to the participants at either session. The results of the two sessions were analysed and compared. RESULTS: Overall, 216 questions were administered to the trainees in the 2-week study, 108 before and 108 after the use of the FBTApp. From the first to the second sessions, a significant increase of correct answers was noted (from 47/108 or 43% to 77/108 or 71%, P < 0.01). Particularly, a better improvement was obtained in the correct labelling of cerebral structures on the nonaxial (from 32% to 67%, +35%) vs axial (from 67% to 81%, +14%) view planes of the brain (P < 0.01). CONCLUSION: The use of FBTApp seems capable to improve the knowledge of the normal fetal brain anatomy in subjects naive to dedicated prenatal ultrasound. This improvement seems greater on nonaxial planes.


Subject(s)
Anatomy, Regional/education , Brain/diagnostic imaging , Fetus/diagnostic imaging , Mobile Applications , Obstetrics/education , Smartphone , Ultrasonography, Prenatal , Anatomy, Cross-Sectional/education , Anatomy, Cross-Sectional/instrumentation , Anatomy, Cross-Sectional/methods , Anatomy, Regional/instrumentation , Anatomy, Regional/methods , Brain/anatomy & histology , Echoencephalography/instrumentation , Echoencephalography/methods , Education, Medical, Graduate/methods , Educational Measurement/methods , Female , Fetus/anatomy & histology , Humans , Imaging, Three-Dimensional , Pregnancy , Software , Surveys and Questionnaires , Ultrasonography, Prenatal/instrumentation , Ultrasonography, Prenatal/methods
12.
J Matern Fetal Neonatal Med ; 32(18): 3068-3073, 2019 Sep.
Article in English | MEDLINE | ID: mdl-29587562

ABSTRACT

Objective: The aim of this study was to evaluate the association between umbilical arterial pH and fetal vertebral artery Doppler velocimetry waveforms measured at the beginning of the second stage of labor in physiological term pregnancies. Methods: This was a prospective cohort study of 250 pregnancies. The resistance index, pulsatility index, and peak systolic velocity were measured. The relationship between the fetal Doppler and the umbilical arterial pH was evaluated. A simple linear regression and a general linear model were used to explore possible correlations of Doppler parameters with fetal and neonatal outcome adjusted for confundents. Results: Umbilical arterial pH values were directly associated with vertebral artery pulsatility index. Fetuses with lower pulsatility index values were at increased risk of a subsequent diagnosis of pathological fetal heart rate tracing patterns (presence of decelerations or reduced variability according to FIGO criteria during the second stage of labor). We estimated a decrease in pulsatility index of 10% in those fetuses destined to show a pathological fetal heart rate tracing. Conclusion: Vertebral artery Doppler waveforms correlates with umbilical pH in normal pregnancies and is also a function of fetal heart rate patterns. If this proportional association would be demonstrated also for abnormal pH values, vertebral artery pulsatility index might be useful to evaluate fetal wellbeing in those cases of suspected hypoxia/academia.


Subject(s)
Heart Rate, Fetal/physiology , Labor Stage, Second , Umbilical Arteries/chemistry , Vertebral Artery/physiology , Adult , Female , Humans , Pilot Projects , Pregnancy , Prospective Studies , Pulsatile Flow , Ultrasonography, Doppler/methods , Ultrasonography, Prenatal/instrumentation , Umbilical Arteries/diagnostic imaging , Vertebral Artery/diagnostic imaging , Vertebral Artery/embryology
13.
Ultrasound Med Biol ; 44(11): 2250-2260, 2018 11.
Article in English | MEDLINE | ID: mdl-30093339

ABSTRACT

We investigated how accurately low-cost ultrasound devices can estimate gestational age (GA) using both the standard plane and the obstetric sweep protocol (OSP). The OSP can be taught to health care workers without prior knowledge of ultrasound within one day and thus avoid the need to train dedicated sonographers. Three low-cost ultrasound devices were compared with one high-end ultrasound device. GA was estimated with the head circumference (HC), abdominal circumference (AC) and femur length (FL) using both the standard plane and the OSP. The results revealed that the HC, AC and FL can be used to estimate GA using low-cost ultrasound devices in the standard plane within the inter-observer variability presented in the literature. The OSP can be used to estimate GA by measuring the HC and the AC, but not the FL. This study shows that it is feasible to estimate GA in resource-limited countries with low-cost ultrasound devices using the OSP. This makes it possible to estimate GA and assess fetal growth for pregnant women in rural areas of resource-limited countries.


Subject(s)
Fetus/anatomy & histology , Gestational Age , Ultrasonography, Prenatal/economics , Ultrasonography, Prenatal/instrumentation , Adult , Developing Countries , Female , Humans , Observer Variation , Poverty , Pregnancy , Reproducibility of Results , Ultrasonography, Prenatal/methods
15.
J Ultrasound Med ; 37(11): 2603-2612, 2018 Nov.
Article in English | MEDLINE | ID: mdl-29689632

ABSTRACT

OBJECTIVES: To determine the feasibility of a telerobotic approach to remotely perform prenatal sonographic examinations. METHODS: Thirty participants were prospectively recruited. Participants underwent a limited examination (assessing biometry, placental location, and amniotic fluid; n = 20) or a detailed examination (biometry, placental location, amniotic fluid, and fetal anatomic survey; n = 10) performed with a conventional ultrasound system. This examination was followed by an equivalent examination performed with a telerobotic ultrasound system, which enabled sonographers to remotely control all ultrasound settings and fine movements of the ultrasound transducer from a distance. Telerobotic images were read independently from conventional images. RESULTS: The mean gestational age ± SD of the 30 participants was 22.9 ± 5.3 weeks. Paired-sample t tests showed no statistically significant difference between conventional and telerobotic measurements of fetal head circumference, biparietal diameter, or single deepest vertical pocket of amniotic fluid; however, a small but statistically significant difference was observed in measurements of abdominal circumference and femur length (P < .05). Intraclass correlations showed excellent agreement (>0.90) between telerobotic and conventional measurements of all 4 biometric parameters. Of 21 fetal structures included in the anatomic survey, 80% of the structures attempted across all patients were sufficiently visualized by the telerobotic system (range, 57%-100% per patient). Ninety-seven percent of patients strongly or somewhat agreed that they would be willing to have another telerobotic examination in the future. CONCLUSIONS: A telerobotic approach is feasible for remotely performing prenatal sonographic examinations. Telerobotic sonography (robotic telesonography) may allow for the development of satellite ultrasound clinics in rural, remote, or low-volume communities, thereby increasing access to prenatal imaging in underserved communities.


Subject(s)
Amniotic Fluid/diagnostic imaging , Fetus/diagnostic imaging , Placenta/diagnostic imaging , Robotics/methods , Ultrasonography, Prenatal/instrumentation , Ultrasonography, Prenatal/methods , Adult , Biometry , Cross-Over Studies , Feasibility Studies , Female , Humans , Pregnancy , Prospective Studies , Reproducibility of Results
16.
J Cardiovasc Magn Reson ; 20(1): 17, 2018 03 12.
Article in English | MEDLINE | ID: mdl-29530064

ABSTRACT

BACKGROUND: Fetal cardiovascular magnetic resonance (CMR) imaging may provide a valuable adjunct to fetal echocardiography in the evaluation of congenital cardiovascular pathologies. However, dynamic fetal CMR is difficult due to the lack of direct in-utero cardiac gating. The aim of this study was to investigate the effectiveness of a newly developed Doppler ultrasound (DUS) device in humans for fetal CMR gating. METHODS: Fifteen fetuses (gestational age 30-39 weeks) were examined using 1.5 T CMR scanners at three different imaging sites. A newly developed CMR-compatible DUS device was used to generate gating signals from fetal cardiac motion. Gated dynamic balanced steady-state free precession images were acquired in 4-chamber and short-axis cardiac views. Gating signals during data acquisition were analyzed with respect to trigger variability and sensitivity. Image quality was assessed by measuring endocardial blurring (EB) and by image evaluation using a 4-point scale. Left ventricular (LV) volumetry was performed using the single-plane ellipsoid model. RESULTS: Gating signals from the fetal heart were detected with a variability of 26 ± 22 ms and a sensitivity of trigger detection of 96 ± 4%. EB was 2.9 ± 0.6 pixels (4-chamber) and 2.5 ± 0.1 pixels (short axis). Image quality scores were 3.6 ± 0.6 (overall), 3.4 ± 0.7 (mitral valve), 3.4 ± 0.7 (foramen ovale), 3.6 ± 0.7 (atrial septum), 3.7 ± 0.5 (papillary muscles), 3.8 ± 0.4 (differentiation myocardium/lumen), 3.7 ± 0.5 (differentiation myocardium/lung), and 3.9 ± 0.4 (systolic myocardial thickening). Inter-observer agreement for the scores was moderate to very good (kappa 0.57-0.84) for all structures. LV volumetry revealed mean values of 2.8 ± 1.2 ml (end-diastolic volume), 0.9 ± 0.4 ml (end systolic volume), 1.9 ± 0.8 ml (stroke volume), and 69.1 ± 8.4% (ejection fraction). CONCLUSION: High-quality dynamic fetal CMR was successfully performed using a newly developed DUS device for direct fetal cardiac gating. This technique has the potential to improve the utility of fetal CMR in the evaluation of congenital pathologies.


Subject(s)
Cardiac-Gated Imaging Techniques , Echocardiography, Doppler , Fetal Heart/diagnostic imaging , Heart Defects, Congenital/diagnostic imaging , Magnetic Resonance Imaging, Cine , Ultrasonography, Prenatal/methods , Boston , Cardiac-Gated Imaging Techniques/instrumentation , Echocardiography, Doppler/instrumentation , Equipment Design , Fetal Heart/physiopathology , Germany , Gestational Age , Heart Defects, Congenital/embryology , Heart Defects, Congenital/physiopathology , Heart Rate, Fetal , Humans , Magnetic Resonance Imaging, Cine/instrumentation , Predictive Value of Tests , Stroke Volume , Sweden , Transducers , Ultrasonography, Prenatal/instrumentation , Ventricular Function, Left
18.
Acta Obstet Gynecol Scand ; 97(1): 97-103, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29068541

ABSTRACT

INTRODUCTION: We aimed to test the reproducibility of head-perineum distance (HPD) measurements using two different ultrasound devices and five examiners, to compare ultrasound measurements and clinical assessments and to study if ultrasound examinations were acceptable for women in labor. MATERIAL AND METHODS: A reproducibility study was performed at Lund University Hospital, Sweden and Landspitali University Hospital, Iceland from February 2015 to February 2017. The study population comprised 40 healthy women in labor. HPD was measured with three replicate measurements from each woman with two different ultrasound devices, and the measurements were compared with clinical assessments. Acceptability was tested with a visual analog scale (VAS), and the mean VAS score from both ultrasound devices was compared with the VAS score from clinical palpation. RESULTS: The median time interval between start of examinations with devices was 10 min (range 1-26 min). The intra-observer repeatability coefficient was 4.3 mm and the intraclass correlation coefficient was 0.97 (95% CI 0.95-0.98). The intraclass correlation coefficient between the two devices was 0.86 (95% CI 0.74-0.93) and limits of agreement were -9.6 mm to 16.6 mm. However, we observed a significant mean HPD difference between devices (3.5 mm; 95% CI 1.4-5.6 mm). Clinical assessments and the mean measurements of HPD were correlated (r = 0.64, p < 0.01). We found significant differences in acceptability in favor of ultrasound. The mean VAS score for both ultrasound devices was 2.0 vs. 4.1 for clinical examination (p < 0.01). CONCLUSION: We found excellent intra-observer repeatability, good correlation but significant difference between devices. Women reported less discomfort with ultrasound than with clinical examinations.


Subject(s)
Labor Presentation , Labor, Obstetric , Ultrasonography, Prenatal , Adult , Dimensional Measurement Accuracy , Equipment Design , Female , Head/diagnostic imaging , Humans , Iceland , Labor, Obstetric/physiology , Labor, Obstetric/psychology , Patient Preference/statistics & numerical data , Perineum/diagnostic imaging , Pregnancy , Reproducibility of Results , Sweden , Ultrasonography, Prenatal/instrumentation , Ultrasonography, Prenatal/methods , Ultrasonography, Prenatal/psychology
19.
J Matern Fetal Neonatal Med ; 31(13): 1787-1791, 2018 Jul.
Article in English | MEDLINE | ID: mdl-28627262

ABSTRACT

PURPOSE: Cervical assessment during digital vaginal examination (DVE) includes assessing cervical dilatation, effacement, position and consistency. Only cervical dilatation during labor has been previously researched. We investigated cervical changes, including cervical dilatation and effacement, using a wireless ultrasound (US) device. MATERIALS AND METHODS: This was a longitudinal study investigating cervical changes during labor using a wireless US device. Twenty-five women in labor participated in a serial comparison of cervical dilatation, length and thickness measured during intrapartum transperineal sonography using a wireless mobile US device (SONON) with measurements of cervical dilatation and effacement obtained during serial DVEs. RESULTS: Intrapartum sonography showed strong correlation with DVE in assessing cervical changes during labor including the measurement of cervical dilatation and thickness (p < .001). The failure rate of cervical length image collection was high; therefore, we could not determine the correlation between cervical length and effacement. CONCLUSIONS: We developed a new technique for evaluating effacement with cervical thickness. Cervical dilation and thickness using a transperineal intrapartum US demonstrated significant correlation with DVE findings. The use of a wireless US device is convenient and may be advantageous in the labor ward; however, further research is needed to define the role of this wireless device.


Subject(s)
Cervix Uteri/diagnostic imaging , Labor Stage, First/physiology , Labor, Obstetric/physiology , Ultrasonography, Prenatal/instrumentation , Cervix Uteri/physiology , Female , Gynecological Examination , Humans , Longitudinal Studies , Pregnancy , Prospective Studies , Regression Analysis
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