Antenatal Ultrasound Examination Research Articles

Analysis of factors associated with the umbilical cord pitch value by ultrasound measurement in late pregnancy

BackgroundThis study aimed to investigate the factors associated with the antenatal umbilical cord pitch value by ultrasound measurement in late pregnancy. We investigated the factors associated with the umbilical cord pitch value under prenatal ultrasound measurement.MethodsThis study included 528 pregnant women who underwent routine antenatal ultrasound examinations in Ningbo Women and Children’s Hospital from December 2020 to August 2021. Their umbilical cord pitch values and diameter, Wharton’s jelly thickness, amniotic fluid indexes, umbilical artery blood flow parameters, and other relevant data, such as ages and gestational ages, were measured. Information about delivery methods, placenta, umbilical cord, and neonatal weight were recorded during follow-up. Statistical analysis was performed on the above data, and the factors associated with the pitch values were analyzed by linear regression.ResultsThis study revealed that cord torsion (p < 0.001, 95% confidence interval [CI]=-34.81 to -19.01), cord entanglement (p < 0.001, 95% CI = 10.71 to 20.11), thickening of Wharton’s jelly (p = 0.001, 95% CI = 5.39 to 20.24), and cord edema (p = 0.015, 95%CI = 2.09 to 19.44), gestational age (p = 0.024, 95%CI = 0.14 to 1.89), age of pregnant woman (p = 0.009, 95%CI= -1.15 to -0.16), and neonatal weight (p = 0.011, 95%CI = 0.002 to 0.012) were significantly correlated with the pitch values.ConclusionThe umbilical cord pitch value significantly correlated with cord entanglement, cord torsion, cord edema, Wharton’s jelly thickening, gestational age, age of the pregnant woman, and neonatal weight. Notably, the pitch value by prenatal ultrasound measurement is predictive of cord morphological abnormalities such as cord entanglement, cord torsion, cord edema, and Wharton’s jelly thickening.

Current practice of placental cord insertion documentation in Australia - A sonographer survey.

During pregnancy, the umbilical cord attaches to the placenta in a central, eccentric, marginal or velamentous location. Maternal and fetal complications are associated with marginal and velamentous cord insertions, the most clinically significant being perinatal mortality due to undiagnosed vasa praevia. Current literature describes a wide variation regarding regulation of placental cord insertion (PCI) documentation during antenatal ultrasound examinations. This prospective cross-sectional study aimed to assess the current practice of antenatal PCI documentation in Australia. Members of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022. Four hundred ninety sonographers met the inclusion criteria for the study of which 330 (67.3%) have more than 10 years' experience as a sonographer and 375 (76.5%) are employed primarily in a public or private setting offering general ultrasound. Most respondents (89.6%) indicated documentation of the PCI site is departmental protocol at the second trimester anatomy scan (17-22 weeks gestation), but PCI documentation is protocol in less than 50% of other obstetric ultrasound examinations listed in the survey. The PCI site is included in the formal ultrasound report at a rate significantly less than inclusion in the departmental protocol and the sonographer's worksheet. Considering the potential maternal and fetal complications associated with abnormal PCI and the ease at which the PCI site is identified in the first and second trimesters, we believe that standard inclusion of the PCI site in departmental protocol and in the formal ultrasound report from 11 weeks gestation, regardless of whether it is normal or abnormal, would prove invaluable.

P-757 The classification and management of adnexal masses identified during pregnancy

Abstract Study question How do we classify adnexal masses (ovarian cysts) identified during pregnancy and how should we manage them? Summary answer Adnexal masses (ovarian cysts) should be managed expectantly in pregnancy, given the low rate of complications and low prevalence of malignancy. What is known already Conservative management of adnexal masses (ovarian cysts) is preferable during pregnancy, due to the maternal and fetal risks associated with surgery. Accurate diagnosis is key to safe expectant management. Various ultrasound-based models exist to classify adnexal masses; however, none have been validated for use in pregnancy. Adnexal mass morphology can change during pregnancy due to decidualisation, which is often difficult to distinguish from underlying neoplastic processes. We aim to evaluate:(1) the performance of current methods of adnexal mass classification in pregnancy, (2) understand the natural course of adnexal masses in pregnancy, particularly the presence of decidualisation and incidence of complications. Study design, size, duration Retrospective analysis of prospectively collected data between January 2017- November 2022. To classify adnexal masses (ovarian cysts), we evaluated: Expert subjective assessment (SA), IOTA Simple Rules (SR) and the IOTA Assessment of Different Neoplasias of the Adnexa (ADNEX) model. The end point was either the histological examination of tissue removed at surgery or the subjective classification of adnexal masses at the postnatal scan in women managed conservatively. Participants/materials, setting, methods Women with an adnexal mass identified on gynaecological ultrasound in pregnancy at a tertiary London University Hospital were included. Relevant clinical data was extracted, including age, gestation and cyst-related complications. Adnexal masses were classified at the first antenatal and postnatal ultrasound examination according to SA, SR and the ADNEX model (10% risk of malignancy cut off) and correlated to histology for adnexal masses managed surgically. IOTA simple descriptors were used to classify benign adnexal masses. Main results and the role of chance 254 women (median age 33-years old, range:18-49) with an adnexal mass/cyst were included at a median gestation of 12 weeks, (range:4-36). 13 (5.1%) conceived through assisted reproductive techniques. Spontaneous resolution occurred in 24.5% of cases, and 21 were lost to follow up (8.3%). According to Simple Descriptors, 38.6% were simple, 22.0% were endometriomas and 19.7% were dermoid cysts. Antenatally, SA outperformed ADNEX, based on specificity (94.6 vs.92.2%) and sensitivity (60 vs.55.6%) respectively. SA and ADNEX had a negative predictive value(NPV) of 96.1% and 98.3% respectively. Postnatally, SA had a higher sensitivity than ADNEX (75 vs.50%), but a lower specificity (94.1 vs.96.9%). SA and ADNEX had a NPV of 94.1% and 97.5% respectively. Three (1.3%) underwent acute surgery during pregnancy: one ovarian torsion (9/40), and two cyst ruptures (11/40, 30/40). Presumed decidualisation occurred in 29.5% of endometriomas. Three (1.3%) underwent cyst removal during caesarean section, two for suspicion of BOTs (one had suspected decidualisation) and one for patient preference. On histology, the suspected decidualised mass was a serous BOT, and the suspected BOT was a struma ovarii. In the postnatal period (12 weeks), four underwent surgery for suspicion of BOTs, two were confirmed BOTs and two were benign cystadenomas on histology. Limitations, reasons for caution The dataset as expected contains a relatively small number of malignancies (prevalence 3.9%) and so any analysis of test performance to discriminate between benign and malignant disease must be interpreted with caution. A larger prospective multicentre study is needed to do this. Wider implications of the findings Our data suggest that a number of cysts in pregnancy will resolve, a few will be associated with acute complications and the risk of malignancy is very low. Accordingly, the study supports an expectant management approach for adnexal masses (ovarian cysts) detected in pregnancy. Trial registration number Not applicable

Study protocol to explore the social effects of environmental exposure and lifestyle behaviours on pregnancy outcome: an overview of cohort of pregnant women study

IntroductionA growing number of international studies have highlighted the adverse consequences of lived experience in the first thousand days of pregnancy and early life on the probability of stillbirth, child...

Distinct presentations and management of hernia of the umbilical cord: 15 years’ experience in a tertiary hospital

BackgroundHernia of the umbilical cord (HUC) is an uncommon type of abdominal wall defect characterized by a hernia of the midgut into the proximal section of the umbilical cord. This is occasionally coupled with other congenital abnormalities. This is frequently misdiagnosed and referred to as “omphalocele minor.” In certain cases, unintentional cord clamping causes iatrogenic intestinal harm. The purpose of this retrospective study is to highlight various aspects of the HUC therapy in 30 patients with typical and unusual presentations in a tertiary care facility as well as intraoperative findings and associated abnormalities.MethodsThirty neonates (21 males and 9 females) with usual and unusual presentations of HUC diagnosed and treated at the King Abdelaziz University Hospital, Jeddah, Saudi Arabia, over 15 years period from 2005 to 2020.ResultsOut of 30 cases included, 17 patients were reducible with simple classical HUC repair. While 13 patients had different presentations, six cases presented with irreducible content due to variable reasons, four cases presented with patent vitellointestinal duct (PVID), 2 cases presented with intestinal obstruction, and one case presented late with epithelialized HUC sac.ConclusionsAttention to HUC should be paid by obstetric professionals in order not to miss it on antenatal ultrasound and careful umbilical cord examination at delivery to avoid clamping of visceral content if present in HUC.

Congenital lymphocytic choriomeningitis virus: A review.

Lymphocytic choriomeningitis virus (LCMV) uses rodents such as mice and hamsters as its principal reservoir. When women acquire LCMV during pregnancy because of contact with rodents, it can lead to congenital LCMV infection, which is associated with high mortality and morbidity. Although the number of cases reported in the literature is increasing, LCMV is rarely mentioned because a history of exposure to rodents is uncommon and mostly unknown. The main objective of this article was to summarize all morphological, antenatal, and postnatal abnormalities that may suggest a congenital LCMV infection. We reviewed PubMed case reports and case series where an antenatal and/or a postnatal description of at least one case of congenital LCMV infection was documented. We found 70 cases of congenital LCMV infection, 68 of which had antenatal or postnatal brain abnormalities, which were mainly chorioretinitis (59/70), hydrocephaly (37/70), microcephaly (22/70), ventriculomegaly (11/70) and periventricular calcifications (11/70). Antenatal and postnatal extracerebral abnormalities were mainly small for gestational age, ascites, cardiomegaly or anemia. Other organ damage was rare, but could include skin abnormalities, hydrops or hepatosplenomegaly. Seventy percent (49/70) of cases had major cerebral abnormalities that could have been detected by antenatal ultrasound examination. Congenital LCMV infection is associated with a significant mortality rate (30%) and survivors often have severe neurologic sequelae. LCMV is a rare congenital infection, but awareness of the various prenatal ultrasound morphological abnormalities should be improved, and LCMV should be considered when first-line etiological explorations are negative, especially when the mother's medical history indicates exposure to rodents.

Sacrococcygeal teratoma: A case report

Sacrococcygeal teratomas (SCTs) are the most common extragonadal germ cell tumors, comprised different types of tissues that come from at least two of three germ cell layers. Depending on the tissues that are included, they are divided into mature, immature, and malignant. The incidence of SCT in infants and children is 1 in 35,000–40,000 live births. We are reporting a case of type I SCT. The patient was gravida 3, para 1, and abortion 1, which was diagnosed during antenatal ultrasound examination at 22 weeks of gestation and the termination was done after counseling the parents. A female fetus with a tumor in the sacrococcygeal region, weighing 800 g was delivered. The baby was sent to the department of anatomy. SCTs develop at the base of the coccyx and are thought to be derived from Henson’s node a rounded and elevated area at the cranial end of the primitive streak. This primitive streak consists of totipotent cells, which are able to transform into any type of cells.

Study of fetal central nervous system anomalies by the means of antenatal 2D ultrasound examination in varying trimesters

Aims and Objectives: 1) Objective is to study the range of Congenital neurological anomalies occurring in utero; 2) To evaluate the incidence of congenital anomalies in varying trimesters; 3) To confirm the diagnosis by post natal examination or autopsy as and when possible. Material and Methods: This is a prospective study which was conducted in the Radio-diagnosis department in Dhiraj General hospital, from January 2021 till February 2022. Ultrasound screening of pregnant women was performed. Pregnancy with ultrasound findings of central nervous system anomalies were followed up. Prenatal ultrasound findings were confirmed by post MTP examination in cases of therapeutic abortions and fetal losses. In case of live birth postnatal findings were noted. Results: After conducting a ultrasound screening in all three trimesters, a total of 30 congenital neurological anomalies were diagnosed. It was seen that majority of anomalies were detected in 2nd trimester. Among the neurological anomalies, most common anomalies were found to be hydrocephalus (4), Anencephaly (3) and lumbar myelo-meningocoele (3). Ultrasound findings were matching in 87 % of cases with post natal examination findings. In this study rare congenital neurological syndromes like Meckel Gruber syndrome and iniencephaly like disorders were also detected via ultrasound.

Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass.

During routine antenatal ultrasound examinations, an ovarian mass can be found incidentally. In clinical practice, the differential diagnosis between benign and malignant ovarian masses is essential for planning further management. Ultrasound imaging has become the most popular diagnostic tool during pregnancy, with the recent development of ultrasonography. In non-pregnant women, several methods have been used to predict malignant ovarian masses before surgery. The International Ovarian Tumor Analysis (IOTA) group reported several scoring systems, such as the IOTA simple rules, IOTA logistic regression models, and IOTA assessment of different NEoplasias in the adneXa. Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score, DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System. These researchers suggested specific features of ovarian masses that can be used for differential diagnosis, including size, proportion of solid tissue, papillary projections, inner wall structure, locules, wall thickness, septa, echogenicity, acoustic shadows, and presence of ascites. Although these factors can also be measured in pregnant women using ultrasound, only a few studies have applied ovarian scoring systems in pregnant women. In this article, we reviewed various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women.

Rare Fetus-in-Fetu: Experience From a Large Tertiary Pediatric Referral Center.

Objective: Fetus-in-fetu (FIF) is an extremely rare disease, and most prior publications are single case reports. Here, we describe the clinical characteristics, imaging manifestations, and the treatment and related complications of FIF from a large tertiary pediatric referral center.Materials: After institutional review board approval, patients with a diagnosis of FIF between January 2010 and November 2019 were further selected and reexamined. We analyzed the general clinical characteristics, imaging manifestations, treatment, and prognosis of the patients.Results: A total of seven (four male and three female) patients with FIF were included in the study. All patients were diagnosed with FIF during the antenatal ultrasound examination along with an abnormal increase in alpha fetoprotein, and it was confirmed by subsequent pathological examination. The median gestation period when FIF was first diagnosed was 25 (range: 22–32) weeks. Ultrasound, computed tomography, and magnetic resonance imaging were the main pre-operative diagnostic techniques used. All patients underwent FIF resection within 1 month after birth: four patients had open surgery and three had laparoscopic surgeries (one case was converted to open surgery); only one patient developed ascites after surgery. All patients are growing up healthy and without tumor recurrence at the last follow-up. The level of alpha fetoprotein decreased to normal within 1 year (range 3-10 months) after surgery performed.Conclusion: As the size of the FIF increases, it can be found and diagnosed in antenatal ultrasound examination. Surgery is an important curative treatment for FIF and generally results in excellent long-term quality of life.

FRASER SYNDROME: A CASE REPORT

Fraser syndrome (cryptophthalmos syndrome) is a congenital anomaly in which cryptophthalmos is the main feature. Other malformations can include syndactyly, craniofacial and urogenital anomalies. It is a rare autosomal recessive condition with FRAS1, FREM2 and GRIP1 genes mutation. We report a case of 2 months old male child born to consanguineous parents. He presented with unilateral cryptophthalmos and some features that were compatible with diagnostic criteria of Fraser syndrome such as syndactyly, high arched palate with ankyloglossia, cryptorchidism and hypospadias. It can be diagnosed by antenatal ultrasound and clinical examination. We also present the criteria for diagnosing Fraser syndrome, its prenatal findings and ocular management.

Efficacy of Antenatal Ultrasound Examination in Diagnosis of Congenital Cardiac Anomalies in an Unselected Population: Retrospective Study from a Tertiary Centre.

In Low- and Middle-Income Countries like India, where the services and surgical care for Congenital Heart Disease (CHD) are available only in selected centres with geographical variations, it is important to detect Heart defects early and give the parents an opportunity to plan ahead for seeking appropriate care at the earliest. Several developments in recent years such as improvement of quality of ultrasound machines, sonographer's experience, skills and better description of cardiac views have contributed to improve detection rate. A retrospective study was done between March 2016 and December 2019, and showed ultrasound evidence of CHD was included. The total number of morphology scans done during study period was 50,435. The number of congenital anomalies detected was 1482, out of which CHD was detected in 334 (22.5%). Outcome of 50 pregnancies were not available while the rest (284) were available for follow up in post-natal period. There were 51 cases of CHD, missed on routine antenatal morphological screening, which were diagnosed in the post-natal period. There were 18 cases of over-diagnosed CHD on antenatal scan, but were found to have normal echo findings after birth. A systematic approach is crucial for practitioner to determine the patterns of associated defects. Use of step wise strategy helps in determining the correct diagnosis of isolated cardiac defect, associated with other system or a part of syndrome. Systematic audit of morphological scans could play an important role in improving the diagnostic accuracy, which in turn will lead to early detection.

Antenatal care and perinatal outcomes of asylum seeking women and their infants.

Asylum seekers have been highlighted as a particularly vulnerable group of expectant mothers due to complex medical and psychosocial needs, as well as the difficulties they may face in accessing care. Our aim was to examine if there were differences in the antenatal care and perinatal outcomes for asylum seeking women when compared to age- and ethnicity-matched controls delivering at the same hospital. Two age- and ethnicity-matched non-asylum seeking controls were identified for each asylum-seeking woman. Electronic patient records were analysed to determine the amount of antenatal care received and neonatal outcomes. Thirty-four asylum-seeking women were identified who had term born infants. The median number of antenatal care episodes at the delivering hospital was significantly fewer amongst asylum-seeking women compared to controls (three vs. nine, p<0.0001). The median number of antenatal ultrasound examinations at the delivering hospital amongst asylum-seeking women was one (IQR 1-2), compared to three (IQR 3-4) in the controls (p<0.0001). The postnatal length of stay was significantly longer for infants of asylum-seeking women (median three vs. twodays, p=0.002). Thirty-seven percent of asylum seeking women but none of the controls required assistance from social services. There was a significant correlation between antenatal and postnatal costs for asylum seeking women (r=0.373, p=0.042), but not for controls (r=0.171, p=0.181). The increased postnatal length of stay in the infants of asylum seeking mothers may reflect their mother's reduced antenatal care and hence insufficient discharge planning for mothers and infants with increased social needs.

Prenatal diagnosis of vascular rings and outcome.

Background :Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth.Objectives :The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome.Methods :This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications.Results :A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19–35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2–5.6 years).Conclusions :Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.

Antenatal ultrasound measurement of fetal-thigh soft-tissue thickness as a predictor of fetal birth weight

Objectives To assess the use of antenatal estimation of fetal-thigh soft-tissue thickness as a predictor for the actual neonatal birth weight (ABW) after delivery. Background Fetal weight estimation has become increasingly important, especially for evaluation of fetopelvic disproportion, decision for mode of delivery in complications of pregnancy, and in detection of intrauterine growth restriction. Patients and methods A prospective study was conducted on 72 pregnant women with different gravidity and parity attending the delivery room at Obstetrics and Gynecology Department, Menoufia University Hospital during April 2019 till June 2020. An antenatal ultrasound examination within 48 h of their delivery was done. The delivered neonates were weighted immediately after delivery to estimate the ABW. Results Of the 72 women included and who delivered within 48 h (ABW range, 2500–4200), their mean age was 26.34 ± 5.49 years, and gestational age was in the range from 37 to 41 years, with a mean of 38.7 ± 0.92 weeks. There were highly statistically significant differences between estimated fetal weight and ABW of the studied cases (P = 0.001). The prediction of fetal weight was similar between the formulas, although estimate of the new algorithm was more accurate, showing positive predictive value of 94% compared with 91% for Hadlock's. Conclusion The study concluded that the estimation of fetal antenatal estimated birth weight using new algorithm of estimated fetal-thigh soft-tissue thickness is more accurate and specific for estimation the expected ABW than using the standard Hadlock's formula.

Estimation of gestational age by ultrasound measurement of fetal transcerebellar diameter

Introduction: Transcerebellar diameter (TCD) normogram predicts gestational age (GA) with an accuracy of 94% in the third trimester. The study aims to evaluate the application and accuracy of Transcerebellar diameter in determining the GA of the fetus and Its Correlation. Material and Methods: A cross-sectional prospective study conducted to determine the different antenatal ultrasound examinations were performed in 100 normal healthy pregnant with single fetus women having between 25 and 32 weeks of gestation. Results: Mothers mean GA on ultrasound was 28.4 ± 0.75 (27–30.2) weeks. The mean fetal biometry parameters including biparietal diameter (BPD) was 73 ± 2.3 mm (67–80), head circumference (HC) was 264 ± 8.7 mm (237.8–311), abdominal circumference (AC) was 244 ± 8.9 mm (226.6–265.9), femur length (FL) was 55 ± 2.1 mm (49.5–59.6), fetal heart rate was 149 ± 8.5 beats (121–175). The mean transcerebellar (TCD) measurement was 31 ± 1.1 mm. The correlation coefficient between the period of gestation and TCD was found to be 0.99 at 27–30 weeks which was statistically significant (P 0.99). Discussion and Conclusion: From the present study, it was observed that the TCD increases linearly with GA. The correlation between GA and the GA by TCD seems to increase from 28 to 30 weeks. There is a good correlation between GA derived from TCD and from established biometric indices like BPD, HC, AC, and femur length.

Towards the scale and menace of unregulated sonography practice in Ghana

Background There is a high demand for medical sonographers, mainly due to high antenatal and other ultrasound examinations. Ghana has 334 registered radiographers and sonographers for a population of 30 million. The non-existence of strict enforcement of mandatory credentialization and licensure for the practice of ultrasonography has made the proliferation by quacks very pervasive in Ghana. However, there is inadequate knowledge about the activities of these unlicensed sonographers. This paper looks at the scale, creation, proliferation, and patronage of unlicensed Sonographers and discusses the impact on Ghana’s health care delivery. Methods The study was a qualitative study using well-structured pretested questionnaires administered to unlicensed sonographers – multiple techniques were used in data collection. Sonographic reports emanating from unlicensed sonographers brought by referred patients to a tertiary hospital were also collated and analyzed. Results A total of 207 unlicensed sonographers were recruited for the survey. The results showed 90% (186) response rates out of which 128 (69%) were males and 58 (31%) were females. All participants were above 25 years. 46.8% of unlicensed sonographers had senior high school (SHS) or tertiary (41.4%) education. Four pathways identified for their proliferation, 32.8% trained by attending sonography short courses, 32.2% by Peer-to-peer hands-on training, 32.2% by unaccredited training schools, 3.8% attended sonography workshop, and 1.0% had no form of training. Radiologists 33%, Licensed Sonographers 29%, Medical Doctors 20%, unlicensed sonographer 16%, and midwives 2% were responsible for their training. The majority (67.2%) worked in hospitals, and 29.6% in diagnostic centers. The facilities’ ownership structure showed 66.7% privately owned, 15.8% government-owned, 14.2% owned by the Christian Health Association of Ghana (CHAG), faith-based health facilities, and 3.3% of respondents set up their personal ultrasound scan center. The majority (82.2%) of respondents believed sonography practice must be rigorously regulated. The overwhelming majority (95.5%) wanted practicing unlicensed sonographers to be allowed to upgrade at accredited ultrasonography schools leading up to their appropriate licensing. Conclusions Regulators must stringently implement guidelines regulating the practice of ultrasound to safeguard patients. However, the 334 licensed sonographers in Ghana is woefully inadequate; therefore, unlicensed sonographers must be persuaded and supported to upgrade. Policy direction is to increase accredited ultrasonography training institutions to facilitate the training of more medical sonographers.

Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review

BackgroundCongenital anomalies are the fifth leading cause of under-5 mortality globally. The greatest burden is faced by those in low/middle-income countries (LMICs), where over 95% of deaths occur. Many of...

Prevalence, risk factors, and outcome of postprocedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome: a large single-center case series

Postprocedural amniotic band disruption sequence is a condition that is associated with intrauterine interventions, and it is characterized by a constriction of the limbs or umbilical cord by fibrous strands, leading to edema, amputation, and/or fetal demise. To evaluate the prevalence of, risk factors for, and the outcome of postprocedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome cases. All consecutive cases of twin-twin transfusion syndrome treated with fetoscopic laser coagulation of the vascular anastomoses at our center between January 2002 and March 2019 were included in the study. The occurrence of postprocedural amniotic band disruption sequence in these cases was recorded, and the potential risk factors were analyzed. Postprocedural amniotic band disruption sequence was detected, at birth, in 2.2% (15/672) of twin-twin transfusion syndrome cases treated with fetoscopic laser surgery, in both the recipients (10/15, 67%) and the donors (5/15, 33%). Postprocedural amniotic band disruption sequence primarily affected the lower extremities (11/15, 73%) and, less frequently, the upper extremities (2/15, 13%), both the upper and lower extremities (1/15, 7%), or the umbilical cord (1/15, 7%). Postprocedural amniotic band disruption sequence led to the amputation of toes in 5 of 15 cases (33%) and resulted in fetal demise because of constriction of the umbilical cord in 1 case (7%). The independent risk factors identified for postprocedural amniotic band disruption sequence were lower gestational age at laser surgery (odds ratio per week, 1.43; 95% confidence interval, 1.12-1.79; P=.003) and the presence of postprocedural chorioamniotic membrane separation on antenatal ultrasound examination (odds ratio, 41.66; 95% confidence interval, 5.44-319.25; P<.001). The prevalence of postprocedural amniotic band disruption sequence is low, but, when present, it may lead to severe consequences, with amputation of extremities or fetal demise occurring in more than one-third of the cases. Lower gestational age at the time of laser therapy and chorioamniotic membrane separation are independent risk factors for the postprocedural amniotic band disruption sequence.

Assessment of the Etiologies and Outcomes of Antenatal Hydronephrosis in Patients at King Abdulaziz University Hospital.

BackgroundAntenatal hydronephrosis (ANH) is the most common congenital abnormality. It is often detected during pregnancy through an antenatal ultrasound (US) examination. This condition is defined as the dilatation of the renal pelvis and/or calyces in neonates. Little is known about ANH and its associated etiology and outcomes, especially in the Middle East. This study aims to determine the outcome of patients diagnosed with ANH between 2011 and 2017.MethodsThe current study was a retrospective analysis of data collected from the medical records of 64 ANH patients (45 male, 19 female). We collected data regarding the demographic characteristics, fetal parameters, laboratory and radiological parameters, and medical and surgical interventions. Moreover, based on radiological reports patients were classified into one of the following two groups: good prognosis, including patients with improved or resolved ANH and poor prognosis, including patients with progressing ANH and associated complications such as parenchymal scarring, chronic kidney disease complicated by secondary hypertension.ResultsOverall, 48.4% of patients exhibited good prognosis, whereas 51.6% exhibited poor prognosis. Among the 64 patients, 53.1% of patients exhibited unilateral ANH, and 46.9% exhibited bilateral ANH. Also, unilateral ANH and bilateral ANH had good prognoses in 41.2% and 56.7%, respectively, while unilateral and bilateral ANH had poor prognosis in 58.8% and 43.3%, respectively.ConclusionsAdditional prophylactic measures should be taken to avoid complications, such as urinary tract infection (UTI), as our study found that patients who have ANH are more prone to develop UTI. Patients with several ANH comorbidities are associated with poor prognosis.