Reproducibility of three-dimensional power Doppler placental vascular indices in pregnancies between 26 and 35 weeks.

PURPOSE: Assess intra and interobserver reproducibility of three-dimensional power Doppler (3DPD) placental vascular indices in normal pregnancies between 26 and 35 weeks. METHODS: Thirty 3D volumes were captured by one observer and stored for analysis. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated from the spherical placental tissue samples obtained through the automatic Virtual Organ Computer-aided AnaLysis (VOCAL). Two observers analyzed the stored volumes and calculated the indices and their findings were compared. Intraclass correlation coefficients (ICCs) were used to analyze intra and interobserver correlations. Data were analyzed using confidence intervals, reliability coefficients and Bland-Altman graphs with concordance limits. RESULTS: All three indices had good intra and interobserver reproducibility. Intraobserver ICCs for the three indices were > 0.90. The FI had the highest ICC (0.99), the highest interobserver ICC (0.98) and the best concordance on the Bland-Altman graphs. CONCLUSION: 3DPD placental vascular indices obtained using the automatic sphere mode had a good intra and interobserver reproducibility for pregnancies between 26 and 35 weeks. The FI obtained the highest reproducibility scores.

Placental blood flow measured by three-dimensional power Doppler ultrasound at 26 to 35 weeks gestation in normal pregnancies.

OBJECTIVE: To evaluate placental vascular indices, in pregnancies between 26 and 35 weeks, using three-dimensional power Doppler (3DPD) ultrasound and the effect of placental location on these indices. METHODS: This was a cross-sectional study involving 283 patients. The placental vascularization index (VI), flow index (FI) and vascularization and flow index (VFI) was obtained using the VOCAL program. Pearson's linear correlation coefficient was used to assess the relationship between gestational age and these indices. Student's parametric t-test and Levene's test were used to analyse the results between VI, FI and VFI and placental location. RESULTS: There was no linear correlation between gestational age (GA) and VI (p = 0.390) and VFI (p = 0.053). Only the FI presented a significant linear correlation (p = 0.004), with a slow increase according to GA. It was possible to construct a reliable nomogram only for this index. There were no significant differences in the VI, FI and VFI according to placental location (p = 0.323, 0.172 and 0.120, respectively). CONCLUSION: Placental FI assessed by 3DPD increases progressively and significantly between 26 and 35 weeks. Placental location has no influence on the three vascular indices studied. The FI reference values obtained in this study can be used as a parameter for future investigations on placental vascularization using 3DPD.

Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography.

The placenta is fundamental for fetal development. It combines the functions of an endocrine organ, kidneys, lungs and intestines, purifying catabolites, oxygenating and nourishing the conceptus. Its fetal portion is the largest part develops from the chorionic sac. The maternal portion, which is smaller, is originated in the endometrium, more specifically in the decidua basalis. The placenta starts its function closer to the fourth week of gestation, when anatomical arrangements for the physiological exchanges are already established. The circulatory function of the placenta appears at an early stage of embryo-placental development and it is strongly related to fetal growth, to the placental size and to uterine and umbilical blood flows. Therefore, an adequate placental angiogenesis is critical for the establishment of a normal placental vascularization with consequent normal development of the fetus. In this review article, the authors discuss about placental ontogeny, focusing on the main aspects of its normal development, and about the recent advances in ultrasonography for the study of the vascular architecture of the placenta through three-dimensional power Doppler ultrasonography.

Comparison of two- and three-dimensional ultrasonography in the evaluation of fetal heart: image quality and time spent in the exam.

OBJECTIVES: To compare fetal heart evaluation done through two-dimensional (2DUS) and three-dimensional ultrasonography (3DUS) as to optimal plane imaging, image quality, and time needed to perform the examination. METHODS: Prospective study involving 12 normal pregnant women, with gestational ages ranging from 22 to 26 weeks, scanned with a VOLUSON 730 with a convex 4.0-7.0 MHz transducer, in both two- and three-dimensional modes. In each case, three basic view planes were obtained: four-chambers view, right, and left ventricular outflow tracts. Each view was subjectively evaluated by three different examiners as to image quality, and graded from 0 (minimum) to 4 (maximum) cross-marks (+). The sum of all grades obtained for each case was used to classify the quality of the exam as unsatisfactory (0 to 1+), poor (2 to 4+), regular (5 to 7+), and good (8 to 12+). The time taken to obtain the views was recorded for each case, starting with the acquisition of the first view on the 2D exam and with the identification and opening of the volume blocks on the three-dimensional software. RESULTS: The number of three-dimensional blocks with good, regular, poor, and unsatisfactory grades were, respectively, 6, 15, 9, and 10. The average in cross-marks of the cases graded good in each group without the worst result for each plane was 8. 2DUS was superior to 3DUS regarding the quality of the images obtained by the three pattern view planes and the average time to obtain high quality view planes was longer for 3DUS when compared to 2DUS. 2DUS offered better quality images and in less time than 3DUS. CONCLUSIONS: Three-dimensional ultrasound is an advancement in fetal heart evaluation; however two-dimensional ultrasound remains the best screening method in diagnosing cardiac malformations, due to the good quality of its images and the lesser time needed to perform the exam.

XI VOCAL (eXtended Imaging VOCAL): a new modality for three-dimensional sonographic volume measurement.

INTRODUCTION: The important technological evolutions that three-dimensional ultrasonography devices have gone through in the last years have brought great benefits for the volumetric measurement of fetal organs and structures. In clinical practice, three-dimensional volumetry has helped to identify abnormalities in fetal compartment and other related organs, assisting in the diagnosis and risk estimation of several pathological conditions in fetal medicine. AIM: The authors describe a new methodology for volumetric calculation through three-dimensional ultrasonography called eXtended Imaging VOCAL (XI VOCAL), which is part of the software Three-dimensional eXtended Imaging (3DXI). This software virtualizes real organs, by analyzing the volume through a diagram of slice sections (Multi-slice view) that simultaneously shows a sequence of images in parallel planes, and establishes the volume of the organ. Because of the importance of accurate volumetric measurements in obstetric ultrasonography, a new method allowing this measurement should be regarded as of great interest.

Diagnosis of uteroperitoneal fistula through color Doppler hysterosonography.

INTRODUCTION: Uterine fistulas are infrequent pathologic entities characterized by abnormal communication of the uterus with any other organ or structure through a perforation formed due to traumatic and infectious conditions among others. The use of hysterosonography as method of diagnosis for that pathologic entity has few descriptions in medical literature. MEDLINE search resulted in only two cases reporting the use of HS in the diagnosis of uterine fistula. OBJECTIVE: Our objective is to report a case of uteroperitoneal fistula caused by uterine trauma during curettage, diagnosed by color Doppler hysterosonogrphy. The importance of our report lies on HS as a simple, safe and low cost method, which can be used for the diagnosis of fistulous processes involving the uterus.

Treatment of twin reversed arterial perfusion sequence by septostomy and amniodrainage: a case report.

INTRODUCTION: An acardiac fetus is the most severe malformation seen in humans. It is an extremely rare complication, occurring in approximately 1% of all monozygotic twin gestations, with an incidence of about 1 in 35,000 births. This malformation happens as a result of the syndrome of reversed arterial perfusion of the acardiac twin from the other normal fetus (pump twin), due to the presence of arterio-arterial anastomoses in a monochorionic placenta. Several obstetric and perinatal complications have been associated to this anomaly and several treatments have been proposed to reduce the morbimortality of the pump twin. There's no report in MEDLINE about the treatment of twin gestations with acardiac fetus through septostomy. CASE REPORT: The present article reports a case of reversed arterial perfusion sequence complicated by polyhydramnios diagnosed at 19th week of pregnancy, treated with septostomy and serial amniodrainage. DISCUSSION: This case presented it demonstrate favorable development of the gestation, with labor happening at 35 weeks gestation and pump twin presenting good vitality conditions. In cases with no major factors of bad prognosis, septostomy combined with amniodrainage could be an interesting therapeutic option for a safe and efficacious management of selected cases of TRAP sequence.