Antenatal Imaging Research Articles

Neonatal Hydrocephalus

Hydrocephalus is one of the most common congenital abnormalities affecting the nervous system, occurring in 0.3 to 2.5 per 1,000 live births. It results from obstruction of cerebrospinal fluid (CSF) pathways by a diverse range of developmental, genetic, and acquired abnormalities and can have negative consequences on the neurodevelopmental outcome of affected neonates. Historically, hydrocephalus was diagnosed after birth and managed with a shunt procedure; however, with the advent of advanced antenatal imaging techniques, it may now be detected and treated before delivery in some individuals. Moreover, surgical options for the treatment of hydrocephalus have increased over the past few decades, and temporary CSF diversion may prevent the need for permanent shunt placement. Posthemorrhagic hydrocephalus is the most common cause of hydrocephalus in the preterm newborn, but the timing of surgical intervention for this condition remains controversial. Recent evidence suggests that earlier, rather than later, intervention may have some benefits, but more data are needed to adequately inform clinical practice. Regardless of etiology or timing of diagnosis, a thorough understanding of the natural history of hydrocephalus and the range of treatment options available is needed for parental counseling, prognostication, and appropriate surgical management.

ANTENATALLY DIAGNOSED UPPER MOIETY HYDRONEPHROSIS IN A CHILD WITH ECTOPIC URETER: A CASE REPORT

An ectopic ureter is any ureter, single or duplex, that does not enter the trigonal area of the bladder. In a duplex system, the ectopic ureter is inevitably the upper pole ureter. In males, the ectopic ureter always enters the urogenital system above the external sphincter. The majority of ectopic ureters are detected through prenatal ultrasound imaging, even if the specific diagnosis is not made until after birth. Radionuclide renal imaging remains the gold standard for renal functional assessment, and this is usually best provided by dimercaptosuccinic acid imaging. The goals of therapy are the preservation of renal function; elimination of infection, obstruction, and reflux; and maintenance of urinary continence. We report a case of a 6-month-old male child presenting with urinary tract infection. The child was diagnosed to have had a cystic dilatation of the right upper moiety on antenatal ultrasonography imaging.

The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States.

The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.

Advanced abdominal pregnancy: a search for consensus. Review of literature along with case report

Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging modalities, undiagnosed cases of advanced abdominal pregnancies are still reported. We report a case of asymptomatic abdominal pregnancy with healthy fetus advanced till 40 + 4weeks period of gestation. Her diagnosis was not established even after obstetrical evaluation and cesarean section at primary care hospital. To the best of our knowledge, less than 10 postdated cases of abdominal pregnancy have been reported so far in the literature. This case emphasizes the need to re-awaken awareness and high index of suspicion to diagnose such cases. Details of all the cases pertaining to advanced abdominal pregnancies reported after 2013 were reviewed and summarized. We searched electronic medical database in English using keywords related to abdominal pregnancy. Bibliographies of the relevant articles of advanced abdominal pregnancy published from 2013 onwards were reviewed and then cross searched to identify further relevant studies. A total of 26 cases of advanced abdominal pregnancy including index one were reviewed. All preoperatively diagnosed cases of abdominal pregnancy at earlier gestation were given conservative management and resulted in live births. The incidence of malformations in live births was 24%. We are of considered opinion that conservative strategy is a feasible option in selected cases of advanced abdominal pregnancy yet there is a need of standardization of treatment principles for such cases to optimize fetomaternal outcome.

Imaging Characteristics of Dural Arteriovenous Fistulas Involving the Vein of Galen: A Comprehensive Review.

Vein of Galen aneurysmal malformation (VGAM) is a rare angiopathy, which most commonly presents in infancy. Although very rare, it is associated with high morbidity and mortality rates. In order to minimize such morbid rates, a prompt diagnosis followed by a timely initiation of management is crucial. Multiple antenatal and postnatal imaging techniques for the diagnosis have been described and discussed in the literature. However, to our knowledge, a comprehensive review exploring such a list of imaging options for VGAM has never been established. We aim to review the diagnostic tools to aid in better understanding of the investigative modalities physicians may choose from when treating patients with a VGAM.

Prenatal [Ultrasound] Diagnosis of Cryptorchid Testicles

The role of ultrasonography as a routine investigative test for diagnosing testicular pathologies (in-utero and postnatally) cannot be overemphasized. Undescended (cryptorchid) testis according to literature is prone to neoplastic transformation. Determination of fetal gender in-utero by ultrasound allows for sex determination albeit; its full ethical implication should be considered. 3D ultrasonography is affordable, ubiquitous, reproducible and ensures rapid evaluation of a wide array of testicular pathologies, early (coincidental) diagnosis is important to avoid complications (such as torsion, bleeding or malignant-mass-formation) thus; sonar imaging features as an indispensable tool. The case aims to document and highlight accidental detection (at 31 weeks gestational age) and expunge on the accuracy of ultrasonography in diagnosing cryptorchidism. There is sparse (Nigerian) literature on Undescended Fetal Testis (UDFT). This report used antenatal imaging as a clear descriptive evidence of faulty testicular descent with detailed examination of the fetal genitalia. Ultrasound examination during the 3rd semester allows for accurate cryptorchid diagnosis (prenataly).

Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study

ObjectiveEstimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.DesignCase–control study.SettingSites in Australia and New Zealand with at least 50 births per year.ParticipantsCases were women...

Fetal Renal Obstruction is Early Detected during Pregnancy by Ultrasonography at Urban Hospital (Naraynganj)

Over the last 3years (September 2012 to September 2015) for the period of 36 months after searching of all gravid uterus ultrasonography report only 40 patients having hydronephrosis detected during antenatal checkup both Naraynganj General Hospital Radiology and Imaging department and Private Clinic, primary finding is oligo hydraminos between 10 weeks to 16 weeks of gestation. All the patients of our study population were subjected to imaging by ultrasonography. This was a prospective study. Out of 40 fetus hydronephrosis were graded according to sonographic grading system. There were two fetus of grade 0, eight fetus of grade-1, eleven fetus grade-2, are nineteen fetus of grade 3 hydronephrosis on advance pregnancyMedicine Today 2016 Vol.28(2): 72-74

Fetal imaging and therapy for CDH—Current status

In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and review the evolution of fetal surgery for CDH to date.

Ultrasound Images and Postnatal Clinical Outcomes in Primary and Secondary Abnormalities of Fetal Brain (Series of 53 Cases)

The objective of study is the analysis of ultrasound (US) images, clinical perinatal and long-term results in different types of primary and secondary abnormalities of the fetal brain. The article contains ultrasound (US) images and postnatal results in 53 fetuses with brain abnormalities detected after ultrasound anomaly scan. The features of fetuses with brain abnormalities were studied and archived. After receiving data about the postnatal catamnesis, a retrospective detailing of antenatal images was conducted. Adverse general postnatal outcome (GPO) meant perinatal or infant death; adverse clinical postnatal outcome (CPO) meant persistent neurological morbidity

Congenital Hepatic Cyst

Congenital hepatic cyst is a rare and nonsymptomatic condition in infants and children. Its incidence is 2.5% in the postnatal life with a much lower incidence in the prenatal period. Incidental finding on antenatal imaging is the most common presentation. We present a case of a newborn in whom fetal ultrasound detected a cyst within the fetal liver. Postnatal imaging revealed a liver cyst in the right lobe of the liver, with no other intrahepatic structure affected. Liver function tests were abnormal, but the patient was asymptomatic. Posterior follow-up imaging showed a minor decrease in size. Management of congenital hepatic cyst is usually conservative, done with periodic ultrasound monitoring. However, surgical treatment is the mainstay of treatment when hydrops, progressive enlargement, hemorrhage, torsion, or compression of adjacent structures occurs. Malignant transformation can occur, but it is extremely rare. Partial or total removal of the cyst is the preferred treatment in neonates with a large lesion.

Uterine artery embolization for management of placenta accreta, a single-center experience and literature review

“Morbidly adherent placenta” is a term that describes the continuum of placenta accreta, increta, and percreta. Placenta accreta is the least invasive form, whereas placenta percreta represents a complete penetration of the trophoblast through the uterus that reaches the serosal surface and potentially invades the bladder, rectal wall, and pelvic vessels. Leaving the placenta in situ in the setting of abnormally invasive placenta is now widely practiced. We herein present three cases of abnormal placental implantation diagnosed by antenatal ultrasound and magnetic resonance imaging, in which uterine artery embolization was performed to induce placental infarction and eventually rapid regression but most importantly to minimize peripartum and postpartum bleeding. As we do this, we sought to review the risks of placenta accreta, increta, and percreta and evaluate the role of endovascular therapy to improve maternal outcomes when abnormal placental implantation occurs.

Symptomatic Neonatal Arterial Ischemic Stroke With Prenatal and Postnatal Neuroimaging.

The authors report a girl born at term via planned cesarean delivery. Three days earlier, an antenatal magnetic resonance imaging study, showing no cerebral lesions in the fetus, was performed. Ten minutes after delivery, signs of progressive respiratory failure developed and the infant was transferred to the intensive care unit. On the next day, a computed tomography (CT) scan showed acute ischemic lesions in the areas of the left middle and posterior cerebral arteries. The exact mechanism of stroke remained unidentified. It is possible that emboli occluded the left middle cerebral artery and left posterior cerebral artery. At the age of 1 year and 4 months, the patient demonstrated a slight right-sided hemiparesis more pronounced in the hand. To our knowledge, there are no prior published case studies reporting a healthy fetal brain, which then undergoes an acute neonatal arterial infarction near or during birth following an elective cesarean delivery.

Stillbirth: a lot done… a lot more to do.

Stillbirth: a lot done… a lot more to do.

The use of obstetric ultrasound in the antenatal diagnosis of craniosynostosis: We need to do better.

The cranial sutures allow for growth of the developing brain in both the pre- and post-natal period but also play a crucial role in vaginal delivery. Birth problems are commonly reported by the mothers of children with craniosynostosis and, in particular, sagittal synostosis. Patients presenting with all forms of craniosynostosis were identified through a search of computer records, and the antenatal imaging was obtained and examined. The fetal cranial measurements including biparietal diameter, occipitofrontal diameter and head circumference were recorded, and the cephalic index (CI) was calculated for each affected fetus. A birth history was also recorded. Scans in both the second and third trimesters were available for 28 fetuses who had sagittal synostosis. Eight fetuses (29%) had a significant reduction in CI (>3) between the morphology and growth scans. There was an increase in the number of emergency caesarean deliveries in women whose fetuses had sagittal synostosis when compared with the general population (22% vs. 17%). The calculation of CI can be performed routinely at antenatal scanning. A value outside the normal range or a change in CI during the pregnancy should prompt detailed scanning of the fetal skull and cranial sutures. This will assist obstetricians with delivery planning.

Correlation of probability scores of placenta accreta on magnetic resonance imaging with hemorrhagic morbidity

Study Objective and DesignTo evaluate the hypothesis that assigning grades to magnetic resonance imaging (MRI) findings of suspected placenta accreta will correlate with hemorrhagic outcomes. We chose a single-center, retrospective, observational design. Setting, Patients, and MeasurementsNulliparous or multiparous women who had antenatal placental MRI performed at a tertiary level academic hospital were included. Cases with antenatal placental MRI were included and compared with cases without MRI performed. Two radiologists assigned a probability score for accreta to each study. Estimated blood loss and transfusion requirements were compared among groups by the Kruskal-Wallis H test. ResultsThirty-five cases had placental MRI performed. MRI performance was associated with higher blood loss compared with the non-MRI group (2600 [1400-4500]mL vs 900[600-1500]mL, P<.001). There was no difference in estimated blood loss (P=.31) or transfusion (P=.57) among the MRI probability groups. ConclusionsIn cases of suspected placenta accreta, probability scores for antenatal placental MRI may not be associated with increasing degrees of hemorrhage. Continued research is warranted to determine the effectiveness of assigning probability scores for antenatal accreta imaging studies, combined with clinical indices of suspicion, in assisting with antenatal multidisciplinary team planning for operative management of this morbid condition.

Congenital Lesions of the Lung

1. Clinicians can provide better care for patients with congenital lung abnormalities when they understand the developmental sequence and different types of abnormalities. 2. Knowing the appropriate antenatal and postnatal imaging strategies for congenital lung abnormalities will optimize diagnosis and guide treatment. After completing this article, readers should be able to: 1. Understand the developmental sequence of congenital lung abnormalities (CLA). 2. Distinguish the different types of CLA. 3. Identify the antenatal and postnatal imaging to optimize the diagnosis of CLA. 4. Know the treatment strategies for CLA. Congenital lung abnormalities (CLAs), also termed bronchopulmonary malformation (BPM), are increasingly identified in the perinatal setting. The use of ultrasonography with improved resolution for antenatal screening, along with supplementary fetal magnetic resonance imaging (MRI) has increased the detection of pulmonary lesions. The estimated incidence is 1 in 2,000 to 1 in 2,500 live births. A large percentage of these will remain asymptomatic in the neonatal period and later. An understanding of the pathophysiology and timing of the development of these lesions is essential in the diagnosis and treatment of these infants. CLAs are likely to represent a spectrum of developmental miscues, along with tracheobronchial obstruction, that result in the downstream formation of these lesions. (1) Lung development occurs through 5 distinct stages as follows: Embryonic (4–7 weeks): Lung buds develop off the primitive foregut. Lobar branching occurs along with vascular inflow and outflow development. Pseudoglandular (7–17 weeks): The tracheobronchial tree grows and branches, ultimately forming 20 generations of airways. Vascular ingrowth matches the tracheobronchial tree to the preacinar level and achieves a mature configuration. Arteries follow airway branching with the veins located in the adjacent connective tissue. Cannicular (16–23 weeks): Terminal branching of the bronchial tree occurs, forming respiratory bronchioles and initiating the formation of air-blood interface along with the differentiation of type 1 and 2 pneumocytes. Type …

Fetal MRI: A Rare Case of Conjoint Twins.

The antenatal magnetic resonance imaging (MRI) of a third-trimester primipara patient showed a fetus in a vertical position with two separate heads, a common thorax, abdomen, and pelvis with a single pair of upper and lower limbs [Figure 1]. Both heads appeared equal and symmetric with normal brain development [Figure 2]. Two separate upper cervical spinal cords fused to form a single spinal cord in the mid/lower cervical spine level. There was a single heart present in the thoracic cavity. The intra-abdominal organs appeared normal in position, structure, and number [Figure 1]. The findings were confirmed at delivery [Figure 3]. Figure 1 Coronal T2-weighted turbo spin echo (TSE) showed the fetus in a vertical position with two separate heads, two cervical spinal cords fusing at the mid-cervical spine level, a common thorax, abdomen, and pelvis, and a single pair of upper and lower limbs ... Figure 2 Coronal T2-weighted turbo spin echo (TSE) the posterior half of the fetal heads showed normally and bilaterally symmetric development of the fetal brains on both sides. Normal appearing cerebral and cerebellar hemispheres, with normal sulci and gyri, ... Figure 3 Postnatal photograph of the baby delivered at 28 gestational weeks by cesarean section. (Informed consent was taken from the parents of this baby for use of this image).

The neonatal chest

The aim of this paper is to describe the most common medical and surgical chest conditions encountered in the premature and term infant, by neonatologists and neonatal surgeons working in a newborn intensive care unit. The paper also reflects the imaging findings as a result of the many advances in the medical treatments used in the treatment of these chest conditions. It also addresses the issues relating to the very premature infants less than 26 weeks gestation. Advances in antenatal imaging lead to antenatal diagnoses in many of the surgical conditions encountered, which allows better postnatal planning and understanding of many of these conditions. Conclusion – Despite the many advances in imaging the Chest Radiograph still remains the primary source of information in the various chest abnormalities in these very sick infants.

Holoprosencephaly: antenatal and postnatal diagnosis and outcome.

The objectives of this study are to ascertain the clinical outcome and overall survival of holoprosencephaly (HPE) patients diagnosed antenatally and postnatally, to determine the accuracy of antenatal diagnosis and to determine the role of neurosurgical intervention in HPE. This is a retrospective review over a 10-year period. Sixty-three patients were included in the study, 45 were diagnosed by antenatal radiological imaging and 18 were diagnosed by postnatal radiological imaging. Patient data was drawn from Temple Street Children's University Hospital (the national paediatric neurosurgery centre), the National Maternity Hospital in Holle's Street, Dublin, and Our Lady of Sick Children Hospital, Dublin. The study was carried out through a review of antenatal and postnatal radiological imaging and reports, clinical charts, GP letters from patient follow-up and telephone conversations with parents of HPE patients. Four patients in the antenatal diagnosis group had follow-up foetal MRI confirming HPE. Twelve in this group had radiological follow-up postnatally, and in five of these, HPE was confirmed. The remaining seven were identified as false positive. Alobar HPE constituted 55% (21/38) of patients with 95% mortality. Fifty-one percent had a normal karyotype. The overall survival in the antenatal diagnosis group was 13%. In the postnatal group, 18 patients were identified, 67% (12/18) lobar and 33% (6/18) semilobar. Normal karyotype was found in 72% (13/18), with an overall survival rate of 56% (10/18). Neurosurgical intervention in both groups mainly consisted of CSF diversion in the form of ventriculoperitoneal (VP) or cystoperitoneal shunt (CP) (13/67). Foetal MRI should be routinely performed in suspected cases of HPE, and reliance on ultrasound alone in the antenatal period may not be sufficient. In our study, there is a high early mortality noted in severe cases of HPE, while milder forms of HPE in children tend to survive beyond infancy albeit with associated complications that required neurosurgical intervention and medical management for other associated systemic anomalies.