Antenatal Ultrasonography Research Articles

Size and Volume Charts for Fetal Adrenal Gland: A Prospective Study in Indian Population

AbstractThe fetal adrenal gland plays a pivotal role in perinatal survival. Because imaging the fetal adrenal gland is not part of routine antenatal ultrasonography (US), there is a paucity of available data about imaging techniques. The purpose of this study was to construct gestational age-wise data for fetal adrenal gland size and volume (2D US measurements) for 20, 21, 22 and 32 weeks of gestation and define a technique to measure the gland ultrasonographically. One year prospective study, at a single centre. 87 consecutive pregnant women with uncomplicated singleton pregnancy were included. Exclusion criteria were multiple pregnancy, maternal complications, congenital anomalies or fetal growth abnormality and a previous child suffering with Congenital Adrenal Hyperplasia (CAH). All measurements were made in 2 dimensional ultrasonography. In coronal sections of the fetal abdomen, fetal adrenal glands were identified just above the upper pole of the kidney to measure length and breadth. With the fetal spine in an anterior position, fetal adrenals were identified on either side of the spine and the width was measured. The gestational age included was 20, 21, 22 and 32 weeks. Both fetal adrenal glands could be visualised and identified in all cases (100%). Length, breadth, width and volume of both the glands for the above gestational ages with 95% confidence limit have been calculated. Antenatal imaging of the fetal adrenal gland can be done by 2D US if indicated.

Fetal Magnetic Resonance Imaging (MRI) in Holoprosencephaly and Associations With Clinical Outcome: Implications for Fetal Counseling.

Holoprosencephaly is the most common malformation of forebrain development and includes a wide spectrum of severity. The objective of this retrospective study was to evaluate fetal magnetic resonance imaging (MRI) associations with outcome. Of the 63 cases identified on antenatal ultrasonography, 28 cases were confirmed on fetal MRI. There were 17 live births; 9 patients died within the first month of life. There were 7 survivors. The vast majority were nonambulatory and required feeding support; none required respiratory support. We found that presence and number of non-holoprosencephaly-associated malformations was also associated with survival. Of 5 patients with 3 or more systemic anomalies, 4 died regardless of holoprosencephaly subtype and 1 was lost to follow-up. Patients with suspected holoprosencephaly on ultrasonography should have full body fetal MRI and echocardiogram to better evaluate systemic anomalies. Counseling should involve pediatric palliative care services to prepare families in caring for babies with limited life span.

Revisiting Strategies for Maternal Health Care in the Face of COVID-19 Pandemic

Novel coronavirus (SARS-CoV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China towards the end of 2019. At present, there is no evidence that pregnant women are more likely to be severely ill, need ICU care, or die from the illness in comparison to non-pregnant adults. Evidences suggest that vertical transmission, might be possible. We searched and retrieved the published literature from PubMed and Google Scholar using various keywords. We further searched the official webpages of various organizations for the updated information. Pregnant individuals in particular are encouraged to take all available precautions to optimize health and avoid exposure to COVID-19. Adequate Testing should be prioritized in pregnant women admitted with suspected COVID-19. When a pregnancy is complicated by critical illness, the pregnant patient should ideally be cared for at a Level III or IV hospital. In the face of COVID-19, antenatal fetal surveillance and ultrasonography should continue as medically indicated when possible and elective ultrasound examinations should not be performed. Maternal immunizations continue to be an essential component of prenatal care and Obgyns should screen all pregnant individuals for mental health issues. Although the most commonly reported sign in COVID-19 is fever, nevertheless, other causes of intrapartum fever should not be overlooked. Cesarean delivery should be based on obstetric indications and not COVID-19 status alone. Infants born to patients with known COVID-19 should be considered infants with suspected COVID-19. The suspected or confirmed COVID-19 mother and infant can be allowed to remain together with enhanced precautions and suspected or confirmed maternal COVID-19 is not a contraindication to breastfeeding. If both the mother and the infant are healthy, it may be prudent to expedite discharge, so as to limit the risk of inadvertent exposure and infection. The Ob-gyns should commit to providing necessary care, although modifications to health care delivery approaches may be necessary.

Perception of Ghanaian Primigravidas Undergoing Their First Antenatal Ultrasonography in Cape Coast.

Ultrasound scans have become an essential requirement of pregnancy care in countries with developed health services and increasingly being used in medical practice in Ghana as well. The aim of this study was to find out the perception of primigravidas experiencing antenatal ultrasonography for the first time in Cape Coast. This was a descriptive, prospective study which employed the use of a questionnaire to obtain data from 384 consented respondents, who were primigravidas experiencing antenatal ultrasonography for the first time in three selected public health facilities in Cape Coast Metropolis over a six-month period. Sociodemographic data, reasons for undergoing antenatal ultrasound, their expectations, knowledge in fetal abnormalities, and suggestions to help improve their future experiences were collected. The data were analyzed using SPSS software, version 20.0 (SPSS Inc., Chicago, IL, USA). Out of a total number of 384 respondents, 87.8% of them knew about what ultrasound is used for. 87.5% scanned because a doctor or midwife requested for the scan whilst 53.9% scanned to check for fetal abnormalities. 98.4% indicated that ultrasound scanning has positive effects on pregnancy outcome. An expensive service was stated as a negative reason that would influence the decision to undergo the examination next time; nonetheless, 90.4% would recommend it to other women and suggested showing the fetus on monitor while scanning and providing accurate findings would make their future experiences better. The perception of the primigravidas was largely positive. Checking for fetal abnormalities was a major reason for the scans, although their knowledge in specific fetal abnormalities was low. They expected to know the fetal sex, but that was not a major reason for scanning. Showing them the monitor was the most frequent suggestion to make future experience better.

Imaging pearls of the annular pancreas on antenatal scan and its diagnostic dilemma: A case report

Background: Annular pancreas is an uncommon cause of duodenal obstruction and rarely causes complete duodenal obstruction. Due to its rarity of identification in the antenatal period and overlapping imaging features with other causes of duodenal obstruction; it is often misdiagnosed.
 Case presentation: A 33-year-old primigravida came for routine antenatal ultrasonography at 28 weeks and 4 days of gestational age. On antenatal ultrasonography, dilated duodenum and stomach were seen giving a double bubble sign and a hyperechoic band surrounding the duodenum. Associated polyhydramnios was also present. Fetal MRI was also done. Postpartum ultrasonography demonstrated pancreatic tissue surrounding the duodenum. The upper gastrointestinal contrast study showed a non-passage of contrast beyond the second part of the duodenum. Due to symptoms of obstruction, the neonate was operated on, and the underlying cause was found to be the annular pancreas.
 Conclusion: Diagnosis of duodenal obstruction due to the annular pancreas is very important in the antenatal period to plan for appropriate therapeutic interventions after birth. A double bubble sign is seen due to various etiologies however the presence of a hyperechoic band in the antenatal ultrasound may point to the diagnosis of the annular pancreas.

Meckel–Gruber Syndrome: Correlation between Ultrasound and Magnetic Resonance Assessment in a Fetal Case with Severe Oligohydramnios

AbstractMeckel–Gruber syndrome (MGS) is a rare genetic condition determined by an autosomal recessive mutation and characterized by occipital cephalocele, postaxial polydactyly, and bilateral dysplastic cystic kidneys, besides many other findings. Antenatal ultrasonography can identify the major features, but in selected cases, magnetic resonance imaging (MRI) might help to obtain the correct diagnosis. We describe a well-documented case of MGS diagnosed by ultrasound in correlation with MRI findings.

VP02.11: Cardiac rhabdomyoma with tuberous sclerosis: a case report

Fetal cardiac rhabdomyoma is very rare; despite the fact that it is the most common prenatally diagnosed cardiac tumour. The imaging technology can find in antenatal period and because most of cases are associated with tuberous sclerosis complex, detecting mutations in the hamartin (TSC1) and tuberin (TSC2) genes could be the way to find causative. A 30-year-old nulligravida women at 38+0 weeks of gestation was referred to St Mary's Hospital, Seoul, for abnormal cardiac ultrasonographic findings. The patient had no genetic diseases and the patient's antenatal examination was normal. Antenatal ultrasonography revealed three echogenic masses in the fetal heart, one each in right atrium, right ventricle and left ventricle, measuring 10, 11, 8mm in diameter. Echocardiography demonstrated multiple cardiac mass although the fetal cardiac function was revealed to be within the normal range. The patient was hospitalised with the onset of spontaneous labour pain in the 39th week of gestation and Caesarean section delivery has done due to non-reassuring fetal status and a female infant weighing 3590g was delivered with Apgar scores of six and nine at one and five minutes after delivery. After birth, postnatal echocardiography confirmed the presence of cardiac rhabdomyoma. There was no evidence of outflow tract obstruction. Additional diagnosis of tuberous sclerosis complex was confirmed by genetic analysis. Analysis of the TSC1 and TSC2 genes were performed and a TSC1 gene de novo frame shift mutation was identified. Magnetic resonance imaging (MRI) for brain demonstrated multiple calcified subependymal nodules and other neurologic evaluation such as electrocardiogram and visual evoked potential was normal. During prenatal life she is clinically silent and undergoing periodic observation.

The Mechanism of Prune Belly Syndrome Development: A Sonographic Sequential Assessment

Prune belly syndrome is a rare disorder characterized by the absence of anterior abdominal wall muscles, bilateral cryptorchidism, and urinary tract malformations. The aim of this case study was to illustrate the developmental sequelae of prune belly syndrome, acquired through a series of antenatal sonography. A 20-year-old woman visited a diagnostic medical sonography center for an obstetrical sonogram. Her fetus was diagnosed with megacystis at 15 weeks’ gestation. The mother returned for repeated appointment and to observe fetal changes during the development of prune belly syndrome. First, the megacystis, hydroureter, and hydronephrosis were noted followed by hazy ascitic and amniotic fluid. The hemodynamics were altered in the umbilical artery, middle cerebral artery, and ductus venosus. Subsequently, the pressure was neutralized, but it was observed after birth that the newborn had cryptorchidism, a distended abdomen with wrinkled wall, and absent right kidney. In conclusion, prune belly syndrome could be caused by megacystis due to bladder outlet obstruction in otherwise normal karyotype fetuses. Megacystis leads to hydroureter, hydronephrosis, and abdominal distention. The persistent abdominal distention gives rise to the underdevelopment of anterior abdominal wall muscles and cryptorchidism.

Fetal Anomalies Associated with Novel Pathogenic Variants in TMEM94.

Background: Intellectual developmental disorder with cardiac defects and dysmorphic facies (IDDCDF, MIM 618316) is a newly described disorder. It is characterized by global developmental delay, intellectual disability and speech delay, congenital cardiac malformations, and dysmorphic facial features. Biallelic pathogenic variants of TMEM94 are associated with IDDCDF. Methods and Results: In a prenatal setting, where fetal abnormalities were detected using antenatal sonography, we used trio-exome sequencing (trio-ES) in conjunction with chromosomal microarray analysis (CMA) to identify two novel homozygous loss of function variants in the TMEM94 gene (c.606dupG and c.2729-2A>G) in two unrelated Saudi Arabian families. Conclusions: This study provides confirmation that TMEM94 variants may cause IDDCDF. For the first time we describe the pathogenicity of TMEM94 defects detected during the prenatal period.

AYURVED APPROACH TO PUTRAGHNI YONIVYAPADA W.S.R. TO HABITUAL ABORTION DUE TO TORCH INFECTION: CASE STUDY

Pregnancy is the start of an incredible journey that leads to great emotional fulfilment to woman. Pregnancy loss is a physically and emotionally demanding for couples. Recurrent Pregnancy Loss (RPL) is also called as Recurrent Miscarriage or Habitual Abortion. It is defined as three consecutive pregnancy losses prior to 20weeks of pregnancy from the last menstrual cycle (LMP). Putraghni is a condition where repeated pregnancy loss occurs because of Artava dosha, Rakta dosha, Ati raktasrava. The article is to understand the Putraghni Yonivyapada w.s.r. to habitual abortion caused due to TORCH Infection and to study the effect of Ayurvedic medicines in the management of Putraghni Yonivyapada w.s.r. to habitual abortion caused due to TORCH Infection. The method is the single arm, open labelled case study of the subject of 27 yrs age having repeated pregnancy loss who has been treated with Shamana Chikitsa throughout pregnancy, Matrabasti and Yonipichu in 8th and 9th months. Pregnancy continued with treatment. Antenatal visits and Ultrasonography observations gave positive outcomes with healthy foetal growth. Patient delivered a full term single live male baby vaginally on 27/10/2019 at 3:20PM with 2.8kg. No birth anomalies were detected. The selected treatment protocol i.e., Shamana Aushadha, Matrabasti and Yonipichu in 8th and 9th month are found very effective in the management of Putraghni Yonivyapada w.s.r. to habitual abortion caused due to TORCH Infection.

SAFE@HOME: Digital health platform facilitating a new care path for women at increased risk of preeclampsia - A case-control study.

In women at risk of developing preeclampsia, we evaluated the use of a digital health platform for telemonitoring blood pressure and symptoms combined with a minimal antenatal visit schedule. A case-control study for women with chronic hypertension, history of preeclampsia, or maternal cardiac or kidney disease. A care path was designed with reduced visits enhanced with a digital platform (SAFE@HOME) for daily blood pressure and symptom monitoring starting from 16weeks of gestation. Home-measurements were monitored in-hospital by obstetric professionals, taking actions upon alarming results. This prospective SAFE@HOME group was compared to a retrospective control group managed without self-monitoring. Primary: healthcare consumption (number of antenatal visits, ultrasounds, admissions and diagnostics), user experiences of the platform. Secondary: maternal and perinatal outcomes. Baseline characteristics of the SAFE@HOME (n=103) and control group (n=133) were comparable. In the SAFE@HOME group, antenatal visits (mean 13.7 vs 16.0, p<0.001) and ultrasounds (6.3 vs 7.4, p=0.005) were lower compared to the control group. Admissions for hypertension or suspected preeclampsia were significantly fewer in the SAFE@HOME group (2.9% versus 13.5%, p=0.004). Telemonitoring participants were highly satisfied using the platform. No differences were observed for maternal and perinatal outcomes. Our care path including blood pressure telemonitoring for women at risk of preeclampsia allows fewer antenatal visits, ultrasounds and hypertension-related admissions. We observed no differences in perinatal outcomes. These results suggest that telemonitoring of blood pressure is feasible in a high-risk pregnant population and has the potential to profoundly change antenatal care.

Is gross morphology of placenta, umbilical cord, and neonatal outcome in well-controlled gestational diabetes mellitus pregnancy different? A case-control study.

BackgroundThe relation of placental gross morphology and the outcome of pregnancies complicated with diabetes mellitus in comparison with healthy pregnancies is not known. Identifying significant differences in pregnancy outcomes in Gestational Diabetes Mellitus (GDM) and healthy pregnancies by the means of morphologic measurements can induce the use of antenatal ultrasonography of placental parameters to predict pregnancy outcomes.ObjectiveThis study aimed to evaluate the relationship between placental morphological parameters of the placenta and cord and the outcomes of pregnancies complicated with diabetes mellitus.Materials and MethodsIn this case-control study, which was conducted at two referral perinatology center in Tehran between March 2017 and November 2018, 60 pregnant women with GDM who were controlled with either diet or insulin as the case group and 60 pregnant women without GDM as the control group were enrolled. The study population were selected from patients who had their prenatal care and delivery in Mahdieh and Shohadaye Tajrish Hospital. The data was collected by taking sickness history, using data from patients files, and measuring of placental and newborn parameters after delivery. GDM was diagnosed either by 75 gr or 100 gr oral glucose tolerance tests. Placenta parameters, umbilical cord features, and newborn outcomes were compared between the two groups.Results Placental weight, diameter, number of lobes, thickness, placental weight to-newborn weight ratio, place of umbilical cord insertion, length, coiling, and diameter of the umbilical cord are similar in two groups. Newborn weight, NICU admission, ABG, and Apgar score are also the same in well-controlled GDM pregnancy and pregnancy without GDM.Conclusion Good controlled GDM causes no difference in placental gross morphology and pregnancy outcome compared to a healthy pregnancy.

Intraventricular Hemorrhage in a Single Fetus of Dichorionic-Diamniotic Gestation: A Case Report and Review of Literature

AbstractIntraventricular hemorrhage (IVH) is a serious complication of prematurity and is of high concern due to the risk of brain injury and in severe cases, death. We report the first case of IVH in a fetus of dichorionic-diamniotic pregnancy that worsened postnatally. Antenatally, magnetic resonance imaging confirmed a large IVH after ventricular abnormalities were detected by prenatal ultrasound (US). At birth, a grade IV IVH diagnosis was made and progressive ventricle dilatation was noted on weekly US. A ventriculoperitoneal shunt was placed and ventricle dilatation was slightly reduced, however, the IVH was essentially unchanged. The infant was discharged in stable condition at 12-weeks-old and chronic neurological dysfunction is expected. IVH is seen in complicated births of prematurity and antenatal US can inform an examiner if fetal IVH is present. It is important to identify IVH and provide immediate intervention to prevent disease worsening during the antenatal and postnatal period.

Identification of Fetal Growth Restriction in Pregnant Women With Prior Bariatric Surgery [16K

INTRODUCTION: Scant formal guidelines exist regarding antenatal ultrasounds in pregnant women with prior bariatric surgery. Considering rates of small-for-gestational-age (SGA) infants may be increased, we investigated whether antenatal ultrasounds were predictive in this population compared to controls. METHODS: Women with prior bariatric procedures were matched to controls by early pregnancy body mass index (BMI). 182 women with prior bariatric procedures and 190 controls were identified and the frequency of prenatal fetal growth restriction and postnatal SGA were examined. Sensitivity, specificity, and area under the curve (AUC) for diagnosis of SGA were calculated for both groups. RESULTS: Among all women with prior bariatric surgery, 116 (63.7%) had two or more ultrasounds after anatomic survey compared to 89 (46.3%) controls. The average BMI in both groups was 35.3 kg/m2. Out of 19 infants found to be SGA at birth in the bariatric procedure group, 7 were diagnosed prenatally. Out of 21 infants with SGA in the control group, 6 were diagnosed prenatally. When analyzing women who had 2 or more ultrasounds after anatomic survey specifically, the sensitivity was 35.3% for prior bariatric surgery and 54.5% for controls. Specificity was greater than 98.5% for both groups. AUC for two or more ultrasounds was 0.766 (95% CI 0.61-0.92) for controls and 0.689 (95% CI 0.57-0.81) for prior bariatric surgery, P=.436. CONCLUSION: Sensitivity for diagnosis of SGA is low in women with prior bariatric surgery, but is not different when compared to BMI-matched controls. The low sensitivity is likely a product of elevated BMI in both groups.

Antenatal diagnosis of bilateral hydronephrosis- A case report

Antenatal ultrasonography has become the frontline investigation for detailed fetal evaluation. Ease of use, widespread accessibility, and prompt diagnosis has given the routine use of ultrasonography a boost with doctors increasingly relying on it in every stage of pregnancy. Fetal hydronephrosis detected as an abnormal dilatation of the urinary canal is one of the most common prenatal anomalies. It is defined by two universally accepted criteria vis-a-vis Society for fetal Urology (SFU) grading and anteroposterior diameter (RAPD) of the renal pelvis. Evaluation antenatal hydronephrosis (ANH) before and after birth is warranted, and factors such as to cause, severity, and whether the condition is uni- or bilateral are used to formulate decisions about additional assessment and potential intervention. Here we present a typical case of bilateral fetal hydronephrosis detected in the 2nd trimester. The progression was analyzed by regular antenatal US and appropriate management instituted.

Meckel-Gruber Syndrome: A Case Report at RHUH

A rare lethal autosomal recessive condition called Meckel-Gruber Syndrome (MGS) has a clinical and genetical heterogenicity. A 15-year-old primigravid presented at the 16th gestational week of her pregnancy at the Rafic Hariri University Hospital (RHUH) for antenatal ultrasonography. She had a third degree consanguineous marriage with no previous uterine scars, no previous invasive testing, no previous fetal anomaly, no comorbidities and no family history of congenital anomalies. On the other hand, her current pregnancy was not the result of an Artificial Reproductive technique (ART) and her medication at home was only based on vitamins and calcium. The antenatal ultrasonography showed the following features: (1) occipital encephalocele (2) diffuse subcutaneous edema (3) bilateral dysplastic kidneys and the bladder was not visualized. These features were suggestive of Meckel Gruber Syndrome (MGS). We concluded that ultrasound in the context of genetic diseases, especially our MGS case, is considered as a secondary prevention tool.

Mutation analysis of the fibroblast growth factor receptor 3 gene in fetuses with thanatophoric dysplasia, type I

Objective: To analyze the fibroblast growth factor receptor 3 gene (FGFR3) mutations in fetuses with thanatophoric dysplasia type I (TD1) and to provide additional data for genotype-phenotype analyses. Materials and Methods: Eight cases of severe fetal short-limb dwarfism detected by antenatal ultrasonography were referred to this center. Before the termination of pregnancy, cordocentesis was performed for FGFR3 gene-sequencing analysis. Postmortem radiographic examination was performed in each instance for definitive diagnosis. Results: By FGFR3 gene sequencing, the authors identified six cases with missense mutations and two cases with stop codon mutations in the FGFR3 gene. Among the 6 FGFR3 missense mutations, four cases revealed a heterozygous p.Arg248Cys mutation, one case had a heterozygous p. Tyr373Cys mutation, and one case had a heterozygous p.Ser348Cys mutation. Discussion: The present data confirm the existence of hotspot FGFR3 mutations of TD1 and suggest that considerable overlap may occur between genotypes and phenotypes among FGFR3-related skeletal dysplasias.

Congenital dacryocystocele diagnosed by antenatal ultrasonography with spontaneous resolution.

Dacryocystocele is a rare benign facial abnormality of the nasolacrimal system, which may be detected at the antenatal workup during the third trimester of pregnancy. Ultrasound is the method of choice for this examination. However, magnetic resonance imaging may also be used in selected cases. Dacryocystocele is mostly a transient finding; it may resolve spontaneously in utero or postnatally. When the defect is bilateral and persists in neonatal life, it may lead to respiratory complications. We report a case of a fetus with bilateral dacryocystocele diagnosed by prenatal ultrasound at the beginning of the third trimester of pregnancy with spontaneous postpartum resorption.

Antenatal ultrasonography depicting congenital high airway obstruction syndrome with duodenal atresia.

Antenatal ultrasonography depicting congenital high airway obstruction syndrome with duodenal atresia.

Ultrasound screening and follow-up study of congenital anomalies of the kidney and urinary tract in neonates

Objective To investigate the incidence of congenital anomalies of the kidney and urinary tract (CAKUT) in neonates, and to evaluate the value of urinary ultrasound screening in the early postnatal period. Methods The neonates born or treated in Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University between January 2016 and December 2018 accepted the urinary ultrasound screening, and the neonates with problem were followed up. In the meanwhile, the maternal pregnancy data were analyzed to screen out the risk factors associated with the onset of CAKUT. Results (1)A total of 2 655 neonates were screened by ultrasonography, of whom 82 neonates had been diagnosed with CAKUT (male: 60 cases, female: 22 cases), the positive rate was 3.1% (82/2 655). There were 66 cases of hydronephrosis, 6 cases of duplicate kidney, 2 cases of multiple renal cysts, 2 cases of renal cystic dysplasia, 1 case of medullary sponge kidney, 3 cases of small kidney, 1 case of isolated kidney, and 1 case of horseshoe kidney. (2)Of the 66 children with hydronephrosis, 4 cases were lost to the follow-up; 8 cases were followed for less than six months with no significant changes found, and still in the follow-up observation; 54 cases were followed up for 1 year, among which 32 cases were returned to normal within 1 year, 3 cases were alleviated, 7 cases were aggravated, and 12 cases were unchanged. One case underwent surgery for repeated urinary tract infections and decreased renal function. (3) Abnormal fetal urinary ultrasound in the late pregnancy was found to be the most common in the high risk factors of CAKUT. There were 44 high-risk newborns with abnormal fetal urinary ultrasound, and 35 cases of CAKUT were diagnosed after birth. The incidence rate was 79.5%(35/44). (4)Among the 2 655 newborns screened, 2 611 newborns had normal antenatal urinary ultrasonography. Among these neonates with normal urinary ultrasound during pregnancy,47 cases of CAKUT were diagnosed after birth, with an incidence of 1.8% (47/2 611). Conclusion The most common CAKUT in neonates is hydronephrosis and most cases with hydronephrosis had a good prognosis, but they should be followed up regularly. Urinary ultrasound screening for neonates, especially those high-risk neonates with abnormal fetal urinary ultrasound, has important clinical implications for the early detection of CAKUT.