Prenatal tomography ultrasound imaging diagnosis of fetal pyriform sinus cysts (third or fourth branchial cleft cyst): A case report.

This case report describes a fetal piriform sinus cyst identified via tomographic ultrasound imaging and discusses its prenatal sonographic characteristics. We employed the tomographic ultrasound imaging function of the GE Voluson Ultrasound E10 to visualize multilevel transverse sections of the cyst. Specifically, we propose for the first time that the cross-sectional shape of a piriform sinus cyst composed of aryepiglottic folds approximates a triangle. This special shape facilitates the precise localization of the piriform sinus, providing valuable insights for timely diagnosis and appropriate postnatal management.

The prenatal diagnosis and prognosis of fetal right aortic arch and double aortic arch malformation: A single-center study.

AIM: This study aimed to characterize the pathological types, diagnosis, chromosomal abnormalities, and postnatal clinical manifestations of right and double aortic arch malformations in fetuses. METHODS: In this retrospective study, all fetuses diagnosed with right or double aortic arch anomalies for whom conventional two-dimensional echocardiography combined with spatio-temporal image correlation was performed at our tertiary referral center between December 2012 and December 2021 were included. RESULTS: In total, 234 fetuses with aortic arch abnormalities were identified. Forty-one cases lost to follow-up. One hundred ninety-three cases were included in this study. One hundred eighty-seven cases with right aortic arch. Six cases with double aortic arch. Most cases of right aortic arch with aberrant left subclavian artery (77/101, 76.2%) were isolated lesions, whereas most of those with mirror-image branching (45/75, 60%) were associated with intracardiac or extracardiac anomalies. Chromosomal abnormalities were screened prenatally in 113 fetuses with right aortic arch, among whom three with aberrant left subclavian artery (3/63, 4.8%) and eight with mirror-image branching (8/50, 16%) had chromosome anomalies (p < 0.05). Furthermore, three cases had microdeletion 22q11.2 and these were significantly associated with intracardiac malformations. CONCLUSIONS: Most cases of isolated right aortic arch do not present with clinical symptoms except isolated left subclavian artery and isolated left brachiocephalic trunk. In addition, the risk of chromosomal abnormalities in patients with isolated right aortic arch is very low. We recommend that pregnant women should be informed of the risks and benefits of undergoing invasive prenatal chromosomal detection.

Hemorrhage complications in obstetric antiphospholipid syndrome: Risk factors and association with adverse pregnancy outcomes.

Background: Bleeding complications are recognized as relatively infrequent manifestations of antiphospholipid syndrome (APS), and the safety of antithrombotic therapy during pregnancy is of concern. This study aims to assess the risk factors and possible associations between bleeding complications and adverse pregnancy outcomes (APOs) in patients with APS. Methods: A retrospective cohort study was conducted at the Peking University People's Hospital. The clinical and immunologic features, bleeding complications, treatment, and pregnancy outcomes of patients with APS were collected. Univariate and multivariate logistic regression analyses were applied to assess the associations between APOs and bleeding complications. Results: A total of 176 participants with obstetric APS were included in the analysis. There were 66 (37.50%) patients with APS with hemorrhage complications and 86 (48.86%) patients with APS with APOs. Mucocutaneous hemorrhage was associated with APOs including fetal death after 12 weeks [odds ratio (OR) = 10.73, 95% confidence interval (CI): 1.61-71.74, p = 0.014], preterm delivery prior to 34 weeks (OR = 8.30, 95% CI: 2.31-29.84, p = 0.001), and small for gestational age (OR = 4.17, 95% CI: 1.22-14.21, p = 0.023) in univariate logistic regression analyses. It also independently associated with preterm delivery prior to 34 weeks (OR = 40.29, 95% CI: 1.45-1121.32, p = 0.030) in multivariate logistic regression analyses. Receiver operating characteristic (ROC) analysis evaluating the accuracy of these factors for preterm delivery prior to 34 weeks showed that the area under ROC curve was 0.871. Conclusion: The study shows that mucocutaneous hemorrhage may be an indication of the occurrence of APOs in obstetric patients with APS.

Effect of regular third-trimester ultrasound examination on antenatal detection and perinatal outcomes of small for gestational age infants.

OBJECTIVE: To assess the effect of regular third-trimester ultrasound on antenatal detection and perinatal outcomes of small for gestational age (SGA) infants. METHODS: Data from SGA infants delivered at ≥28 weeks' gestation were retrospectively studied. Each pregnancy had undergone three regular third-trimester ultrasound examinations, and data were grouped according to with or without antenatal ultrasound suspicion of fetal growth restriction (FGR). Adjusted risk ratios (aRRs) of perinatal outcomes were analysed. RESULTS: A total of 407 infants were included, comprising 268 (65.85%) with antenatal ultrasound suspicion of FGR. Antenatal suspicion of FGR was associated with increased risk of iatrogenic delivery (aRR 2.03, 95% confidence interval [CI] 1.31, 3.14) that included risk of preterm birth (aRR 10.61, 95% CI 1.35, 83.62) and elective caesarean section (aRR 1.306, 95% CI 1.051, 1.623). Differences in fetal death, 1-min Apgar score, and admission to neonatal intensive care unit were not statistically significant. Resuscitation risk was reduced (aRR 0.22, 95% CI 0.06, 0.79). CONCLUSIONS: Regular use of third-trimester ultrasound in one teaching hospital in China showed satisfactory antenatal detection of FGR among SGA infants. Ultrasound suspicion of FGR was associated with higher incidence of iatrogenic deliveries, but not improved neonatal outcomes, except for reduced perinatal resuscitation.

Prenatal diagnosis of congenital portosystemic shunt: A single-center study.

AIM: To review our experience with the prenatal diagnosis of congenital portosystemic shunt (CPSS). METHODS: This is a retrospective study of CPSS cases examined at an ultrasonographic tertiary referral center from 2013 to 2019. The anatomical origin and drainage of the shunt were assessed. Feto-maternal clinical characteristics and long-term outcomes were investigated via medical files and telephone interviews with the mothers. RESULTS: Eleven cases were reviewed. Based on the anatomical origins, before or after portal vein division, cases were classified into extrahepatic portosystemic shunt (EHPSS, n = 3, 27.3%) and intrahepatic portosystemic shunt (IHPSS, n = 8, 72.7%). Additional abnormalities were also observed in the EHPSS (n = 2, 66.7%) and IHPSS (n = 3, 37.5%) groups. Intrauterine growth restriction was the most common abnormality (n = 4, 80%). The median age of the pregnant women was 31.9 years (range 26 ~ 43 years). Most cases (n = 8, 72.7%) were diagnosed in the third trimester, and the median gestational age was 31+5 weeks (range 24 ~ 36+6 weeks). Three cases underwent karyotype examinations, and one had trisomy 13. The median time after birth was 2 years (range 0.7 ~ 5.7 years). The overall postnatal live-birth rate was 60% (6/10), not including one case with no data on pregnancy outcome. The mothers of the six live births indicated that their children were in excellent health. CONCLUSION: This study indicates that prenatal CPSS diagnosis is feasible, especially in the third trimester. IHPSS is more common than EHPSS. Complicated cases most often occur with EHPSS. Intrauterine growth restriction is the most common concomitant abnormality. The prognosis of most cases is good.

The construction and application of an ultrasound and anatomical cross-sectional database of structural malformations of the fetal heart.

OBJECTIVES: Establish a fetal heart anatomical cross-sectional database that correlates with screening transverse ultrasound images suggested by international professional organizations to detect congenital heart defects. METHODS: Fetuses with suspected congenital heart defects identified using the following cardiac image sequences obtained from transverse slices beginning from the upper abdomen and ending in the upper thorax were the subjects of this study: (1) four-chamber view, (2) left ventricular outflow tract view, (3) three-vessel right ventricular outflow tract view, and (4) the three-vessel tracheal view. A database of digital two-dimensional images of the transverse sweep was created for fetuses with confirmed congenital heart defects. In addition, using four-dimensional ultrasound spatial-temporal image correlation, selected transverse ultrasound images were acquired as part of the database. Ultrasound-detected congenital heart defects were confirmed postnatally from pathological specimens of the heart and lungs using a cross-sectional technique that mirrored the ultrasound images described above. When anatomical specimens were not available, prenatal ultrasound-detected congenital heart defects were confirmed using postnatal echocardiography and/or following surgery. RESULTS: The four screening views described in the Methods section identified 160 fetuses that comprised the database. Forty-five datasets consisted of both ultrasound and anatomical cross-sectional images. Thirteen percent (6/45) only had abnormalities of the four-chamber view (eg, endocardial cushion defects). Twenty-four percent (11/45) had abnormalities of the four-chamber view as well as right and left outflow tracts (eg, complex malformations). Of these, 10 of 11 had an abnormal tracheal view. Sixteen percent (7/45) had an abnormal four-chamber view and abnormal right outflow tract (eg, pulmonary stenosis). Thirty-three percent (15/45) had a normal four-chamber view but had abnormal right and left outflow tracts as well as an abnormal tracheal view (eg, tetralogy of Fallot, D-transposition of the great arteries). CONCLUSIONS: Combining both ultrasound and anatomical imaging may be of assistance in training imagers to recognize cardiovascular pathology when performing the screening examination of the fetal heart.

Correction to: Prenatal Ultrasonic Diagnosis and Prognostic Analysis of Isolated Left Subclavian Artery (ILSCA) and Left Brachiocephalic Trunk (ILBCT) Malformation.

The article Prenatal Ultrasonic Diagnosis and Prognostic Analysis of Isolated Left Subclavian Artery (ILSCA) and Left Brachiocephalic Trunk (ILBCT)Malformation, written by Yuntao Li, Xiaohong Zhang, Yani Yan and Qiuyan Pei, was originally published electronically on the publisher's internet portal (currently SpringerLink) on August 2018 with open access.

Prenatal Ultrasonic Diagnosis and Prognostic Analysis of Isolated Left Subclavian Artery (ILSCA) and Left Brachiocephalic Trunk (ILBCT) Malformation.

The purpose of the study was to explore the prognosis, as well as antenatal ultrasonic features of isolated left subclavian artery (ILSCA) and isolated left brachiocephalic trunk (ILBCT) malformations, in order to improve prognosis and provide guidance for prenatal diagnosis. The origin and routing of cephalic and cervical vessels were observed in patients diagnosed with right aortic arch or right arterial duct arch in our hospital from March 2015 to March 2017, and the spectrum features related to ILSCA and ILBCT were analyzed. Fetuses diagnosed as ILSCA, or, and ILBCT were followed up for 3 months after birth. At the same time, a literature review was carried out for ILBCT and ILSCA in Pubmed. In our study, two cases with ILSCA and ILBCT were both diagnosed prenatally. They are not accompanied by other congenital malformations or chromosome abnormalities. No abnormality was found during postnatal follow-up except that left radial pulsation was weakened and blood pressure of the left upper limb decreased in baby with ILSCA. In baby with ILBCT, in addition to these abnormal changes, the left common carotid artery pulse disappearance too. In pubmed, three of 12 ILSCA or ILBCT did not have other congenital malformation or chromosome abnormalities. They were not diagnosed until the age of 3, 10, and 47 because of school exams or atypical symptoms, such as headaches, chest pain. Symptom of ILBCT or ILSCA without other abnormality is silent, and therefore they cannot be diagnosed timely after birth prenatal diagnosis is necessary for they can be treated in time.

Prenatal ultrasonic diagnosis and differential diagnosis of isolated right aortic arch with mirror-image branching.

PURPOSE: This study sought to evaluate the fetal echocardiography features of isolated right aortic arch (RAA) with mirror-image branching and to improve the rate and accuracy of prenatal diagnosis of this condition. METHODS: We reviewed fetal echocardiograms from all cases of isolated RAA with mirror-image branching diagnosed at our institution between August 2012 and December 2015 and classified these cases into normal and abnormal types of ductus arteriosus based on the course of the arterial duct arch. We confirmed the diagnoses by postnatal echocardiography. RESULTS: A total of 11 cases of isolated RAA with mirror-image branching, with the left ductus and the descending aorta located on the left side of the spine, were diagnosed using fetal echocardiography. Ten cases involved normal ductus arteriosus, with the left ductus connecting the left pulmonary artery to the descending aorta, five of which were referred to our institution for suspicions of double aortic aorta. 1 case involved abnormal ductus arteriosus, with the left ductus connecting the left pulmonary artery to the left innominate artery. CONCLUSIONS: RAA with mirror-image branching can be detected via fetal echocardiography, which can reveal the relationship between of the aortic arch and the trachea and can enable the identification of the course of brachiocephalic branching. The identification of isolated RAA with mirror-image branching is crucial for distinguishing this condition from other types of aortic arch anomalies, particularly double aortic aorta, which can have a rather different prognosis.

Continuous transverse scanning of the fetal heart using a cross-sectional image database of common fetal congenital heart deformities.

OBJECTIVE: To provide an anatomical basis for continuous transverse scanning of the fetal heart by analyzing the typical cross-sectional characteristics of different types of congenital heart deformities (CHDs) using an anatomical image database. MATERIALS AND METHODS: The database consisted of cross-sectional images obtained from 45 cases of common fetal CHDs, which were continuously displayed by the three-dimensional software Amira 5.3.1. The following anatomical parts were observed from the database of heart samples in a bottom-to-top manner: the coronary sinus, four chambers, left ventricular outflow tract, right ventricular outflow tract, and transverse ductal and aortic arches. The anatomical characteristics of these sections were analyzed and compared with the ultrasonic transverse views obtained from the same fetuses. RESULTS: During the display of the anatomical database of 45 cases of common fetal CHDs, the aforementioned typical cross sections were successively revealed, along with the corresponding pathological features. These sections also exhibited a very good correspondence with the ultrasonic transverse views of the same cases. CONCLUSION: The database of cross-sectional anatomical images of fetal CHDs provided an anatomical basis for continuous transverse scanning of the fetal heart.

The Application of an Anatomical Database for Fetal Congenital Heart Disease.

BACKGROUND: Fetal congenital heart anomalies are the most common congenital anomalies in live births. Fetal echocardiography (FECG) is the only prenatal diagnostic approach used to detect fetal congenital heart disease (CHD). FECG is not widely used, and the antenatal diagnosis rate of CHD varies considerably. Thus, mastering the anatomical characteristics of different kinds of CHD is critical for ultrasound physicians to improve FECG technology. The aim of this study is to investigate the applications of a fetal CHD anatomic database in FECG teaching and training program. METHODS: We evaluated 60 transverse section databases including 27 types of fetal CHD built in the Prenatal Diagnosis Center in Peking University People's Hospital. Each original database contained 400-700 cross-sectional digital images with a resolution of 3744 pixels × 5616 pixels. We imported the database into Amira 5.3.1 (Australia Visage Imaging Company, Australia) three-dimensional (3D) software. The database functions use a series of 3D software visual operations. The features of the fetal CHD anatomical database were analyzed to determine its applications in FECG continuing education and training. RESULTS: The database was rebuilt using the 3D software. The original and rebuilt databases can be displayed dynamically, continuously, and synchronically and can be rotated at arbitrary angles. The sections from the dynamic displays and rotating angles are consistent with the sections in FECG. The database successfully reproduced the anatomic structures and spatial relationship features of different fetal CHDs. We established a fetal CHD anatomy training database and a standardized training database for FECG. Ultrasound physicians and students can learn the anatomical features of fetal CHD and FECG through either centralized training or distance education. CONCLUSIONS: The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in anatomy and FECG teaching and training.

Establishment of a database of fetal congenital heart malformations and preliminary investigation of its clinical application.

OBJECTIVE: The aim of this study was to create a database of anatomical ultrathin cross-sectional images of fetal hearts with different congenital heart diseases (CHDs) and preliminarily to investigate its clinical application. MATERIALS AND METHODS: Forty Chinese fetal heart samples from induced labor due to different CHDs were cut transversely at 60-µm thickness. All thoracic organs were removed from the thoracic cavity after formalin fixation, embedded in optimum cutting temperature compound, and then frozen at -25°C for 2 hours. Subsequently, macro shots of the frozen serial sections were obtained using a digital camera in order to build a database of anatomical ultrathin cross-sectional images. RESULTS: Images in the database clearly displayed the fetal heart structures. After importing the images into three-dimensional software, the following functions could be realized: (1) based on the original database of transverse sections, databases of sagittal and coronal sections could be constructed; and (2) the original and constructed databases could be displayed continuously and dynamically, and rotated in arbitrary angles. They could also be displayed synchronically. The aforementioned functions of the database allowed for the retrieval of images and three-dimensional anatomy characteristics of the different fetal CHDs, and virtualization of fetal echocardiography findings. CONCLUSION: A database of 40 different cross-sectional fetal CHDs was established. An extensive database library of fetal CHDs, from which sonographers and students can study the anatomical features of fetal CHDs and virtualize fetal echocardiography findings via either centralized training or distance education, can be established in the future by accumulating further cases.

Cytogenetic analysis of 355 cases of fetal loss in different trimesters.

OBJECTIVE: We estimated the success rates of cytogenetic analyses in different tissue samples after intrauterine fetal deaths and analyzed the value of cytogenetic testing for determining the causes. METHODS: Women with intrauterine fetal deaths (occurring at > 10 weeks of gestation) were offered either invasive testing before medical induction of labor, or solid tissue biopsy diagnosis after delivery. RESULTS: A total cohort of 355 intrauterine fetal deaths was studied. During antepartum examinations, invasive procedures included amniocentesis (AMC), chorionic villus sampling (CVS) and umbilical cord (UBC) sampling. During postpartum examinations, samples were taken from unfixed specimens of fetal skin, placenta and other tissues. Chromosomal abnormalities were observed in 22 fetal deaths for which cytogenetic analyses were successful. Logistic regression analysis identified antepartum invasive sampling [P = 0.000, odds ratio (OR) 31.125, 95% confidence interval (CI) 14.265-67.908] to be associated with a high cytogenetic success rate and older age with fetal deaths (P = 0.104, OR 0.487, 95% CI 0.204-1.160) not to be associated with a high chromosomal abnormality. In the patients with recurrent pregnancy loss, the chromosomal abnormality rate of 18.6% of spontaneous abortions has not been significantly more than that of fetal deaths 11.5% (P = 0.437). CONCLUSION: Parents should be counseled on all aspects of cytogenetic analysis after fetal death. Antepartum testing after pregnancy loss is recommended.

Construction of a three-dimensional anatomical database of the human fetal heart.

The objective of this study was to establish an anatomical atlas and a three-dimensional model of the fetal heart. To do this, we created a 60-microm cross-sectional image database of the heart of a Chinese male fetus. A 31-week stillborn fetus with no congenital defects was used as the model. All thoracic organs were removed from the thoracic cavity after formalin fixation and then frozen at -25 degrees C for 2 h. Frozen serial sections, 60-microm thick, were prepared and macroshot with a digital camera to obtain image data. Eight hundred seventy-one cross-sectional photos of the fetal heart were made at a resolution of 3888 x 2592 pixels. The atrioventricular cavity, as well as other fine structures, was revealed in the images, showing a clear boundary between the peripheral tissues. This rich database showing the three-dimensional features and anatomy of the fetal heart will be useful for teaching, scientific research, and clinical applications.