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1.
PLoS One ; 15(7): e0226755, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722675

RESUMO

Digital Infrared Thermal Imaging (DITI) has much potential in the field of maternal-fetal health and wellbeing research. The fact that it is totally non-invasive is particularly important in this context. The purpose of this study was, for the first time, to assess DITI's ability to record fetal presentation and position, and other pregnancy-related physiological factors, via their superficial thermal prints. Ten healthy pregnant women (approximately 34-37 weeks of gestation) were recorded with two thermal imaging cameras (Flir C3 and i3 TE-Q1) from five different viewpoints. Participants' views about the use of DITI in research and clinical practice were also assessed by a completion of a survey. Free hand polygon region of interests (ROIs) were drawn in order to include the entire anatomical area for investigation. The use of free hand polygon ROIs showed high reliability. Thermal images analysis revealed that fetuses presenting cephalically can be identified by the use of DITI, under specific conditions. Fetal movements influenced the thermal patterns that were produced. Future studies need to verify the heat patterns on the skin related to the placenta location, in order to understand the produced thermal recordings. Pregnant women rated the idea of using DITI in research and clinical practice very highly. This work represents a first contribution towards the use of DITI for the recording of fetal presentation and position. As it does not require direct contact and since it is completely non-invasive, it could be used to record maternal-fetal dynamic dyadic interaction in pregnancy. However, although the preliminary results are promising, further trans-disciplinary studies with a well-established protocol, more sophisticated thermal cameras, and bigger cohorts are needed.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico , Feto/diagnóstico por imagem , Termografia/métodos , Adolescente , Adulto , Temperatura Corporal , Estudos de Viabilidade , Feminino , Monitorização Fetal/métodos , Movimento Fetal , Idade Gestacional , Inquéritos Epidemiológicos , Humanos , Processamento de Imagem Assistida por Computador , Apresentação no Trabalho de Parto , Gravidez , Adulto Jovem
2.
PLoS One ; 15(7): e0235310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697776

RESUMO

BACKGROUND: Auditory steady-state responses (ASSRs) are ongoing evoked brain responses to continuous auditory stimuli that play a role for auditory processing of complex sounds and speech perception. Transient auditory event-related responses (AERRs) have previously been recorded using fetal magnetoencephalography (fMEG) but involve different neurological pathways. Previous studies in children and adults demonstrated that the cortical components of the ASSR are significantly affected by state of consciousness and by maturational changes in neonates and young infants. To our knowledge, this is the first study to investigate ASSRs in human fetuses. METHODS: 47 fMEG sessions were conducted with 24 healthy pregnant women in three gestational age groups (30-32 weeks, 33-35 weeks and 36-39 weeks). The stimulation consisted of amplitude-modulated (AM) tones with a duration of one second, a carrier frequency (CF) of 500 Hz and a modulation frequency (MF) of 27 Hz or 42 Hz. Both tones were presented in a random order with equal probability adding up to 80-100 repetitions per tone. The ASSR across trials was quantified by assessing phase synchrony in the cortical signals at the stimulation frequency. RESULTS AND CONCLUSION: Ten out of 47 recordings were excluded due to technical problems or maternal movements. Analysis of the included 37 fetal recordings revealed a statistically significant response for the phase coherence between trials for the MF of 27 Hz but not for 42 Hz. An exploratory subgroup analysis moreover suggested an advantage in detectability for fetal behavioral state 2F (active asleep) compared to 1F (quiet asleep) detected using fetal heart rate. In conclusion, this pilot study is the first description of a method to detect human ASSRs in fetuses. The findings warrant further investigations of the developing fetal brain.


Assuntos
Córtex Auditivo/fisiologia , Encéfalo/fisiologia , Potenciais Evocados Auditivos/fisiologia , Magnetoencefalografia , Córtex Auditivo/diagnóstico por imagem , Percepção Auditiva/fisiologia , Encéfalo/diagnóstico por imagem , Pré-Escolar , Eletroencefalografia , Feminino , Feto/diagnóstico por imagem , Feto/fisiologia , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
3.
PLoS One ; 15(7): e0235836, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649730

RESUMO

Muscle ultrasound density (MUD) is a non-invasive parameter to indicate neuromuscular integrity in both children and adults. In healthy fetuses and infants, physiologic MUD values during development are still lacking. We therefore aimed to determine the physiologic, age-related MUD trend of biceps, quadriceps, tibialis anterior, hamstrings, gluteal and calf muscles, from pre- to the first year of postnatal life. To avoid a bias by pregnancy-related signal disturbances, we expressed fetal MUD as a ratio against bone ultrasound density. We used the full-term prenatal MUD ratio and the newborn postnatal MUD value as reference points, so that MUD development could be quantified from early pre- into postnatal life. Results: During the prenatal period, the total muscle group revealed a developmental MUD trend concerning a fetal increase in MUD-ratio from the 2nd trimester up to the end of the 3rd trimester [median increase: 27% (range 16-45), p < .001]. After birth, MUD-values increased up to the sixth month [median increase: 11% (range -7-27), p = 0.025] and stabilized thereafter. Additionally, there were also individual MUD characteristics per muscle group and developmental stage, such as relatively low MUD values of fetal hamstrings and high values of the paediatric gluteus muscles. These MUD trends are likely to concur with analogous developmentally, maturation-related alterations in the muscle water to peptide content ratios.


Assuntos
Feto/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Animais , Animais Recém-Nascidos , Bovinos , Feminino , Humanos , Recém-Nascido , Doenças Neuromusculares/diagnóstico por imagem , Gravidez , Ultrassonografia , Ultrassonografia Pré-Natal
4.
Medicine (Baltimore) ; 99(25): e20679, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569198

RESUMO

The aim of this study was to quantify changes in the lateral ventricular volume, the depth of the calcarine sulcus (CS), and apparent diffusion coefficient (ADC) values of occipital lobe in fetuses with isolated mild ventriculomegaly (IMVM) using MRI.Seventy-one fetuses with IMVM at 25 to 38 weeks gestational age (GA) and 58 fetuses with normal lateral ventricles at 25 to 38 weeks GA were enrolled. Volumes of the lateral ventricles were measured by 3D magnetic resonance hydrography. Depths of the CS and ADC values were also evaluated. All differences were tested by t test. Bivariate correlations were performed using Pearson method.Fetuses with IMVM had significantly larger lateral ventricular volumes and smaller CS depths than controls (volumes: 9.37 ±â€Š2.20 mL vs 5.04 ±â€Š1.33 mL, respectively, P < .001; depths: 8.27 ±â€Š2.55 mm vs 10.30 ±â€Š3.14 mm, respectively, P < .001). In IMVM cases, the CS depths were smaller on the side with the larger ventricle (8.10 ±â€Š2.54 mm vs 9.59 ±â€Š2.81 mm, P < .001). No differences were observed in occipital lobe ADC values between the2 groups (IMVM = 1.80 ±â€Š0.24 µm/ms; controls = 1.78 ±â€Š0.28 µm/ms, P > .05).Fetuses with IMVM had larger lateral ventricular volumes, shallower CS depths, but normal occipital lobe ADC values.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Feto/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Ventrículos Laterais/diagnóstico por imagem , Lobo Occipital/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Feminino , Idade Gestacional , Humanos , Imageamento Tridimensional , Gravidez , Reprodutibilidade dos Testes
5.
Niger J Clin Pract ; 23(6): 864-869, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525124

RESUMO

Background: An important component of the first-trimester scan is nuchal translucency thickness at 11 weeks to 13 weeks 6 days of gestation. A nuchal translucency ≥3.3 mm is a significant early pregnancy scan finding associated with Trisomies 13, 18, and 21 and congenital heart diseases. Aims: To determine the prevalence and outcome of increased fetal nuchal translucency among pregnant women. Subjects and Methods: A prospective cohort study at the Obstetrics and Gynaecology Department of Usmanu Danfodiyo University Teaching Hospital Sokoto. This was a prospective study of 265 consecutively recruited women in the first trimester of pregnancy who presented to antenatal clinics over a 20-week period. An NT scan was conducted at 11 weeks to 13 weeks 6 days followed by an anomaly scan at 18-22 weeks. Patients were followed up to delivery and 6-week post-partum. The neonates were examined at delivery and at 6-week postnatal life. Data entry and analysis was done with IBM SPSS version 20. The level of significance was set at less than 0.05. Frequency distribution; student t-test and Chi-squared test. Results: The 95th percentile NT was 3.3 mm and the prevalence of increased NT above 3.3 mm was 3%. The mean maternal age of the participants was 28.1 ± 5.1 years and the modal parity was Para 0. The most common anomalies associated with increased NT were ventricular septal defect and spina bifida. A congenital anomaly was significantly associated with increased NT (P < 0.001). Conclusions: The prevalence of increased fetal nuchal translucency is relatively high in our environment and is associated with congenital fetal defects. Routine screening with first-trimester ultrasound will help detect congenital anomalies early.


Assuntos
Transtornos Cromossômicos/diagnóstico por imagem , Feto/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Medição da Translucência Nucal/estatística & dados numéricos , Adulto , Aberrações Cromossômicas , Estudos de Coortes , Feminino , Idade Gestacional , Cardiopatias Congênitas , Hospitais de Ensino , Humanos , Recém-Nascido , Idade Materna , Nigéria/epidemiologia , Medição da Translucência Nucal/métodos , Gravidez , Primeiro Trimestre da Gravidez , Prevalência , Estudos Prospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
6.
PLoS One ; 15(5): e0232769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392232

RESUMO

The end timing of T waves in fetal electrocardiogram (fECG) is important for the evaluation of ST and QT intervals which are vital markers to assess cardiac repolarization patterns. Monitoring malignant fetal arrhythmias in utero is fundamental to care in congenital heart anomalies preventing perinatal death. Currently, reliable detection of end of T waves is possible only by using fetal scalp ECG (fsECG) and fetal magnetocardiography (fMCG). fMCG is expensive and less accessible and fsECG is an invasive technique available only during intrapartum period. Another safer and affordable alternative is the non-invasive fECG (nfECG) which can provide similar assessment provided by fsECG and fMECG but with less accuracy (not beat by beat). Detection of T waves using nfECG is challenging because of their low amplitudes and high noise. In this study, a novel model-based method that estimates the end of T waves in nfECG signals is proposed. The repolarization phase has been modeled as the discharging phase of a capacitor. To test the model, fECG signals were collected from 58 pregnant women (age: (34 ± 6) years old) bearing normal and abnormal fetuses with gestational age (GA) 20-41 weeks. QT and QTc intervals have been calculated to test the level of agreement between the model-based and reference values (fsECG and Doppler Ultrasound (DUS) signals) in normal subjects. The results of the test showed high agreement between model-based and reference values (difference < 5%), which implies that the proposed model could be an alternative method to detect the end of T waves in nfECG signals.


Assuntos
Eletrocardiografia , Feto/diagnóstico por imagem , Modelos Teóricos , Processamento de Sinais Assistido por Computador , Adulto , Algoritmos , Feminino , Humanos , Gravidez
7.
Medicine (Baltimore) ; 99(16): e19786, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311988

RESUMO

The posterior fossa is an important brain structure containing the cerebellum, cerebral ventricle, and cistern. Early evaluation of the cerebellar structure and function may be valuable for early detection of fetal deformities. At present, no normal value for the fetal posterior fossa has been established yet. This study is aimed to investigate the development of the posterior fossa in normal Chinese fetuses by using magnetic resonance imaging (MRI).Pregnant women who need MRI scan were enrolled in our Hospital between January 2012 and December 2014. The fetal supero-inferior diameter (SID), anterio-posterior diameter (APD), cerebellar vermis area, cerebellar width (CW), cerebellar volume (CV), superior cerebellar cistern width, and cerebellomedullary cistern width were measured using MRI. Pearson's correlation analysis was used to detect the relationship between those parameters and gestational age. A regression analysis was performed for all parameters.A total of 92 participants were retrospectively enrolled finally. The results indicated SID, APD, cerebellar vermis area, CW, and CV were positively associated with gestational age, while no significant correlation was found between the superior cerebellar cistern width and cerebellomedullary cistern width and gestational age. Each equation was established.Our study demonstrated that MRI has the advantages over ultrasound imaging for prenatal evaluation of the fetal posterior fossa with multiple views. Normal value of the posterior fossa of Chinese fetuses was established in this study.


Assuntos
Cerebelo/diagnóstico por imagem , Feto/diagnóstico por imagem , Crânio/embriologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Gravidez , Valores de Referência , Estudos Retrospectivos , Crânio/diagnóstico por imagem
8.
Proc Natl Acad Sci U S A ; 117(18): 10035-10044, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312804

RESUMO

One factor that contributes to the high prevalence of fetal alcohol spectrum disorder (FASD) is binge-like consumption of alcohol before pregnancy awareness. It is known that treatments are more effective with early recognition of FASD. Recent advances in retrospective motion correction for the reconstruction of three-dimensional (3D) fetal brain MRI have led to significant improvements in the quality and resolution of anatomical and diffusion MRI of the fetal brain. Here, a rhesus macaque model of FASD, involving oral self-administration of 1.5 g/kg ethanol per day beginning prior to pregnancy and extending through the first 60 d of a 168-d gestational term, was utilized to determine whether fetal MRI could detect alcohol-induced abnormalities in brain development. This approach revealed differences between ethanol-exposed and control fetuses at gestation day 135 (G135), but not G110 or G85. At G135, ethanol-exposed fetuses had reduced brainstem and cerebellum volume and water diffusion anisotropy in several white matter tracts, compared to controls. Ex vivo electrophysiological recordings performed on fetal brain tissue obtained immediately following MRI demonstrated that the structural abnormalities observed at G135 are of functional significance. Specifically, spontaneous excitatory postsynaptic current amplitudes measured from individual neurons in the primary somatosensory cortex and putamen strongly correlated with diffusion anisotropy in the white matter tracts that connect these structures. These findings demonstrate that exposure to ethanol early in gestation perturbs development of brain regions associated with motor control in a manner that is detectable with fetal MRI.


Assuntos
Consumo de Bebidas Alcoólicas/fisiopatologia , Encéfalo/fisiopatologia , Transtornos do Espectro Alcoólico Fetal/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Imagem de Difusão por Ressonância Magnética , Modelos Animais de Doenças , Etanol/toxicidade , Feminino , Transtornos do Espectro Alcoólico Fetal/diagnóstico por imagem , Desenvolvimento Fetal/efeitos dos fármacos , Feto/diagnóstico por imagem , Feto/efeitos dos fármacos , Humanos , Macaca mulatta , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Estudos Retrospectivos
9.
Radiology ; 295(3): 664-674, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32255418

RESUMO

Background MRI performed at 3.0 T offers greater signal-to-noise ratio and better spatial resolution than does MRI performed at 1.5 T; however, for fetal MRI, there are concerns about the potential for greater radiofrequency energy administered to the fetus at 3.0-T MRI. Purpose To compare the specific absorption rate (SAR) and specific energy dose (SED) of fetal MRI at 1.5 and 3.0 T. Materials and Methods In this retrospective study, all fetal MRI examinations performed with 1.5- and 3.0-T scanners at one institution between July 2012 and October 2016 were evaluated. Two-dimensional (2D) and three-dimensional (3D) steady-state free precession (SSFP), single-shot fast spin-echo, 2D and 3D T1-weighted spoiled gradient-echo (SPGR), and echo-planar imaging sequences were performed. SAR, SED, accumulated SED, and acquisition time were retrieved from the Digital Imaging and Communications in Medicine header. Data are presented as mean ± standard deviation. Two one-sided tests with equivalence bounds of 0.5 (Cohen d effect size) were performed, with statistical equivalence considered at P < .05. Results A total of 2952 pregnant women were evaluated. Mean maternal age was 30 years ± 6 (age range, 12-49 years), mean gestational age was 24 weeks ± 6 (range, 17-40 weeks). A total of 3247 fetal MRI scans were included, with 2784 (86%) obtained at 1.5 T and 463 (14%) obtained at 3.0 T. In total, 93 764 sequences were performed, with 81 535 (87%) performed at 1.5 T and 12 229 (13%) performed at 3.0 T. When comparing 1.5- with 3.0-T MRI sequences, mean SAR (1.09 W/kg ± 0.69 vs 1.14 W/kg ± 0.61), mean SED (33 J/kg ± 27 vs 38 J/kg ± 26), and mean accumulated SED (965 J/kg ± 408 vs 996 J/kg ± 366, P < .001) were equivalent. Conclusion Fetal 1.5- and 3.0-T MRI examinations were found to have equivalent energy metrics in most cases. The 3.0-T sequences, such as two-dimensional T1-weighted spoiled gradient-echo and three-dimensional steady-state free precession, may require modification to keep the energy delivered to the patient as low as possible. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Feto/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Diagnóstico Pré-Natal/métodos , Adolescente , Adulto , Criança , Relação Dose-Resposta à Radiação , Feminino , Idade Gestacional , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Gravidez , Razão Sinal-Ruído , Adulto Jovem
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 94-99, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32146737

RESUMO

Objective: To explore the relationship between fetal nuchal translucency (NT) in the first trimester and pregnancy outcome. Methods: A prospective cohort study was conducted in Nanjjing Drum Tower Hospital from December 2015 to December 2018, 4 958 singleton pregnant women were enrolled to screen fetal ultrasound structure and serology in the first trimester, ultrasound in the second trimester and neonatus physical examination 28 days after birth. According to the results of NT, 167 cases of fetus with increased NT (≥3.0 mm) and 4 791 cases of normal NT were divided, moreover, 86 cases with isolate increased NT and 81 cases of increased NT combined with structural abnormality. The prognosis of fetuses with different NT thickness was analyzed, and the pregnancy outcome of fetuses with isolate increased NT or combined with structural abnormality were analyzed. In the first trimester, if the fetal structure was abnormal or the serological screening result was high risk, the chromosomal microarray analysis (CMA) would be performed by chorionic villus sampling to determine the prenatal diagnosis. Results: (1) The pregnancy outcome for fetus of normal NT: there were 4 791 cases with normal NT. Totally, 4 726 cases with normal NT and no structural abnormalities were screened out in the firsttrimester. In this group, 5 cases of aneuploidies were diagnosed based on high risk of maternal serum biomarkers and 83 cases of structural abnormalities were screened out in the subsequent ultrasound scan and the neonatal examination. Another 65 cases with normal NT present complicated with structural anomalies were screened out in the first trimester and 4 cases were diagnosed as aneuploidies. (2) The pregnancy outcome for fetus of isolate increased NT: 66 (76.7%, 66/86) cases of isolated increased NT were performed CMA, 3 cases were diagnosed as trisomy 21 and terminated pregnancy. Another 4 cases were terminated pregnancy privately without cytogenetic diagnosis. No further anomalies were found in 79 cases till 6 to 21 months postnatally. (3) The pregnancy outcome for fetus of increased NT with structural anomalies: increased NT present with structural anomalies were screened out by detailed anomaly scan in the first trimester and 32 of them were confirmed as aneuploidies. In this group, 70 cases terminated pregnancy, 2 cases had spontaneous miscarriages and 9 cases had liveborns (1 newborn was found ventricular septal defect). (4) The pregnancy outcome for fetus of increased NT with or without structural anomalies: the percentage of aneuploidies in fetuses with isolated increased NT (3.5%, 3/86) was significantly lower than those with structural abnormalities (39.5%,32/81). The healthy survival rate in fetuses with isolated increased NT (91.9%,79/86) was significantly higher than those with structural abnormalities (9.9%, 8/81). Conclusions: A detailed first-trimester anomaly scan could improve prenatal screening efficiency of birth defects. Compared to the fetuses with increased NT combined with structural abnormalities, the healthy survival rate of fetuses with isolated increased NT based on detailed first-trimester anomaly scan is higher and the percentage of fetal aneuploidies is lower.


Assuntos
Feto/diagnóstico por imagem , Medição da Translucência Nucal/métodos , Resultado da Gravidez , Ultrassonografia Pré-Natal/métodos , Aneuploidia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/etiologia , Feminino , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos
11.
Pan Afr Med J ; 35: 8, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32117523

RESUMO

Conjoined twins are a rare malformation of monozygotic and mono-amniotic twin pregnancies. We report the case of a patient in whom dicephalic conjoined twins was diagnosed in the antenatal period at 37 week amenorrhea. Fetal prognosis is very poor and, if the diagnosis has been made early, it most often requires therapeutic abortion. The purpose of this case study was to remind clinicians of this very rare disease, of the importance of ultrasound as an essential diagnostic tool to implement a strategy to manage patients in the postpartum period and of prognosis which is most often very guarded.


Assuntos
Feto/diagnóstico por imagem , Gêmeos Unidos , Ultrassonografia Pré-Natal , Feminino , Feto/anormalidades , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Gravidez de Gêmeos , Adulto Jovem
12.
PLoS One ; 15(2): e0226741, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023263

RESUMO

AIMS: Fetuses affected by congenital heart defects (CHD) are considered to be at increased risk of fetal growth restriction and intrauterine demise. Whether these risks are a direct consequence of fetal CHD or a result of associated uteroplacental dysfunction is not evident from the data of recent studies. The aim of this study was to investigate the prevalence of uteroplacental dysfunction reflected by abnormal uterine artery Doppler indices and reduced fetal growth in CHD pregnancies. METHODS: This is a retrospective case-control study including singleton pregnancies referred for detailed fetal cardiac assessment subsequently diagnosed with or without CHD. Mid-trimester uterine artery Doppler assessment at 20-24 weeks as well as third trimester fetal biometry and arterial Doppler pulsatility indices (PI) were performed. All fetal biometry were converted into centiles and Doppler values to multiples of median (MoM) to adjust for physiological changes with gestation. RESULTS: The study included 811 pregnancies including 153 cases where the fetus was diagnosed with CHD. Mid-pregnancy uterine artery PI was significantly higher in women with fetal CHD compared to controls (0.90MoM vs 0.83MoM; p = 0.006). In the third trimester, median centiles for fetal head circumference (45.4 vs 57.07; p<0.001), abdominal circumference (51.17 vs 55.71; p = 0.014), estimated fetal weight (33.6 vs 56.7; p<0.001) and cerebroplacental ratio (CPR: 0.84MoM vs 0.95MoM; p<0.001) were significantly lower in fetuses with CHD compared to controls. The percentage of small for gestational age births <10th centile (24.0% vs 10.7%; <0.001) and low CPR <0.6MoM (11.7% vs 2.5%; p<0.001) were significantly higher in the fetal CHD cohort. CONCLUSIONS: Mid-pregnancy uterine artery resistance is increased and subsequent fetal biometry reduced in pregnancies with CHD fetuses. These findings suggest that fetal CHD are associated with uteroplacental dysfunction, secondary to impaired maternal uteroplacental perfusion resulting in relative fetal hypoxaemia and reduced fetal growth.


Assuntos
Feto/anormalidades , Feto/irrigação sanguínea , Cardiopatias Congênitas/fisiopatologia , Circulação Placentária , Adulto , Biometria , Feminino , Feto/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Gravidez , Ultrassonografia Doppler , Artéria Uterina/anormalidades , Artéria Uterina/diagnóstico por imagem
13.
Pediatr Surg Int ; 36(4): 415-429, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32072236

RESUMO

Congenital diaphragmatic hernia (CDH) is a developmental birth defect consisting of a diaphragmatic defect and abnormal lung development. CDH complicates 2.3-2.8 per 10,000 live births. Despite efforts to standardize clinical practice, management of CDH remains challenging. Frequent re-evaluation of clinical practices in CDH reveals that management of CDH is evolving from one of postnatal stabilization to prenatal optimization. Translational research reveals promising avenues for in utero therapeutic intervention, including fetoscopic endoluminal tracheal occlusion. These remain highly experimental and demand improved antenatal diagnostics. Timely diagnosis of CDH and identification of severely affected fetuses allow time for delivery planning or in utero therapeutics. Optimal perinatal care and surgical treatment strategies are highly debated. Improved CDH mortality rates have placed increased emphasis on identifying and monitoring the long-term sequelae of disease throughout childhood and into adulthood. We review the current management strategies for CDH, highlighting where progress has been made, and where future developments have the potential to revolutionize care in this vulnerable patient population.


Assuntos
Gerenciamento Clínico , Feto/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Guias de Prática Clínica como Assunto , Diagnóstico Pré-Natal/métodos , Feminino , Fetoscopia/métodos , Seguimentos , Hérnias Diafragmáticas Congênitas/diagnóstico , Humanos , Recém-Nascido , Gravidez , Fatores de Tempo
14.
PLoS One ; 15(1): e0227872, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978157

RESUMO

This study aimed to examine age-specific reference intervals and growth dynamics of the best fit for liver dimensions on the diaphragmatic surface of the fetal liver. The research material consisted of 69 human fetuses of both sexes (32♂, 37♀) aged 18-30 weeks. Using methods of anatomical dissection, digital image analysis and statistics, a total of 10 measurements and 2 calculations were performed. No statistical significant differences between sexes were found (p>0.05). The parameters studied displayed growth models that followed natural logarithmic functions. The mean value of the transverse-to-vertical diameter ratio of the liver throughout the analyzed period was 0.71±0.11. The isthmic ratio decreased significantly from 0.81±0.12 in the 18-19th week to 0.62±0.06 in the 26-27th week, and then increased to 0.68±0.11 in the 28-30th week of fetal life (p<0.01). The morphometric parameters of the diaphragmatic surface of the liver present age-specific reference data. No sex differences are found. The transverse-to-vertical diameter ratio supports a proportionate growth of the fetal liver. Quantitative anatomy of the growing liver may be of relevance in both the ultrasound monitoring of the fetal development and the early detection of liver anomalies.


Assuntos
Diafragma/crescimento & desenvolvimento , Desenvolvimento Fetal/fisiologia , Fígado/crescimento & desenvolvimento , Pesos e Medidas Corporais , Diafragma/diagnóstico por imagem , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Lactente , Fígado/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
15.
Sci Rep ; 10(1): 1402, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996751

RESUMO

The aim of this prospective cohort study was to investigate the association between intrauterine fetal growth patterns and periodontal status in pregnant women. Fifty-three pregnant women were recruited. Periodontitis was diagnosed based on probing pocket depth and clinical attachment level. Maternal urinary 8-hydroxy-2'-deoxyguanosine levels and body mass index were recorded. Ultrasonographic measurements of the biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were recorded, and estimated fetal weight (EFW) was calculated. In addition, approximation spline curves of BPD, AC, FL, and EFW were obtained throughout the gestation period. Recorded delivery outcomes were gestational age (GA), birth weight and length, sex, placental weight, and umbilical cord length. Forty-four participants (34.1 ± 4.9 years) were analyzed. Mean neonatal birth weight was 2906.0 ± 544.4 g. On multiple regression analysis, birth weight was related with periodontitis (standardized ß = -0.21, P = 0.001). For EFW and BPD, the curves of the periodontitis group were located lower than those of the non-periodontitis group, with significant differences after 32 weeks and 20 weeks of GA, respectively. In conclusion, periodontal treatment before conception may be recommended and a good periodontal condition in the early stage of pregnancy at the latest is desirable for infant growth.


Assuntos
Desenvolvimento Fetal/fisiologia , Saúde Materna , Periodontite/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Peso ao Nascer/fisiologia , Feminino , Feto/diagnóstico por imagem , Feto/fisiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Estudos Longitudinais , Índice Periodontal , Periodontite/diagnóstico , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Prospectivos , Ultrassonografia Pré-Natal
16.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
17.
World Neurosurg ; 138: 645-653, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31931232

RESUMO

BACKGROUND: The article uses ultrasound imaging standard section to examine the fetal central nervous system (CNS) in early pregnancy, combined with ultrasound imaging in the diagnosis of fetal CNS malformation in the middle and late pregnancy, to determine the feasibility of ultrasound imaging in the detection of CNS abnormalities in the first trimester of the fetus. METHODS: The article selected 2701 pregnant women from the Department of Ultrasound in our hospital from November 2012 to November 2016 to screen for the transparent layer of the fetal neck in early pregnancy, with a total of 2751 cases. The article uses Madison V20 and Madison XG color Doppler ultrasound diagnostic instruments, the probe frequency is measured from 2.0-3.5 MHz, grouped according to gestational age, the statistical section of the case is displayed, and the transparent layer of the neck value is used to count the ultrasound image during early pregnancy. The detection of the CNS malformation by the standard section examination and the sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis may affect the cause of the CNS display rate. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the ultrasound standard section in the diagnosis of fetal CNS malformation in early pregnancy were 85.7%, 100%, 100%, and 99.9%, respectively. Through research, it is found that the use of ultrasound imaging standard section can effectively diagnose fetal CNS severe deformity in early pregnancy, and the detection rate of CNS malformation in early pregnancy is 85.7%. At the same time, the number of positive cases and CNS malformations in this group were few. CONCLUSIONS: The positive cases detected in early pregnancy were severe malformations of the CNS. The diagnosis of other CNS malformations in the fetus needs further study.


Assuntos
Feto/diagnóstico por imagem , Malformações do Sistema Nervoso/diagnóstico por imagem , Obstetrícia/métodos , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos , Feminino , Feto/anormalidades , Seguimentos , Humanos , Malformações do Sistema Nervoso/embriologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez
18.
AJR Am J Roentgenol ; 214(1): 218-231, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31714849

RESUMO

OBJECTIVE. The purpose of this article is to describe the imaging findings associated with complex fetal abdominal wall defects and provide an algorithmic method for arriving at a final diagnosis. CONCLUSION. Fetal ventral abdominal wall defects are a complex group of conditions with a broad spectrum of associated multisystem anomalies and manifestations. Correct characterization and classification of these defects require not only familiarity with imaging findings but also a systematic approach to avoid diagnostic confusion.


Assuntos
Parede Abdominal/anormalidades , Parede Abdominal/diagnóstico por imagem , Algoritmos , Feto/anormalidades , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal , Feminino , Humanos , Gravidez
20.
Respir Physiol Neurobiol ; 271: 103288, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505274

RESUMO

Fetuses of many species, including humans, breathe during development. This fetal breathing aids in lung development, strengthens respiratory muscles, and is posited to fine-tune the neural circuitry that drives breathing. Previous studies suggested that fetal breathing could begin as early as the fifteenth day of gestation in the mouse, but fetal breathing movements (FBMs) had not been observed in mice in utero. We aimed to determine if and when FBMs commence in mice and if they change over time. We examined unanesthetised pregnant C57BL6 mice with ultrasound beginning on the seventh day of gestation. We first reliably observed episodic FBMs in mice on embryonic day 16. FBMs were sporadic, clustered, or rhythmic, and their frequency increased with age. Ultrasound examination of FBMs in mice has great potential utility in the study of transgenic mouse models to help us understand the prenatal characteristics of breathing related human developmental disorders, including Congenital Central Hypoventilation Syndrome (CCHS) and apnea of prematurity.


Assuntos
Desenvolvimento Fetal/fisiologia , Pulmão/diagnóstico por imagem , Pulmão/embriologia , Mecânica Respiratória/fisiologia , Animais , Feminino , Feto/diagnóstico por imagem , Feto/embriologia , Camundongos , Camundongos Endogâmicos C57BL , Gravidez , Respiração
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