Antenatal Ultrasound Scan Research Articles

Autosomal recessive renal tubular dysgenesis: antenatal ultrasound scanning and molecular investigations.

This study aimed to elucidate the fetal ultrasound characteristics, pathology, and molecular genetic etiology of autosomal recessive tubular dysplasia. This retrospective study examined four fetuses with autosomal recessive tubular dysplasia (ARRTD) from two pregnancies, utilizing ultrasound evaluations and fetal renal pathology. Whole-exome sequencing-copy number variation analysis was employed to identify gene mutations. We present for the first time renal vascular resistance in fetuses with ARRTD, characterized by increased renal blood flow resistance and reversed diastolic blood flow, indicating fetal renal insufficiency. This is the first report of a nonsense mutation (C.571C>T) found in the angiotensinogen gene. ARRTD disease should be strongly suspected when ultrasound examinations reveal increased renal blood flow resistance, oligohydramnios, and inadequate bladder filling, regardless of the presence of renal abnormalities.

Protocol for an intervention for new parents experiencing moderate psychosocial adversity: pilot feasibility randomised trial

ABSTRACT Background Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. Method This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and ‘virtual home visits’ during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. Conclusion To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.

Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study

Pregnancies with large for gestational age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options including expectant management, induction of labour and caesarean birth. For women to be able to make an informed decision about birth, antenatal detection of large for gestational age is essential. To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth. In this retrospective cohort study, we analysed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication, as well as a subgroup where the reason for scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW centile, for estimated fetal weight as well as for neonatal weight. We also tested performance of an uncustomized standard, with Hadlock fetal weight >90th centile and neonatal weight >4kg. We calculated diagnostic characteristics for the whole population as well as groups with different maternal body mass indices. The study cohort consisted of 26,527 pregnancies which on average had a scan at 256 days gestation and delivered 20 days later at a median of 276 days (interquartile range 15). In total 2241 (8.4%) of neonates were large for gestational age by customized centiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th centile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with sensitivity of 77.1% and false positive rate 36.0%. When comparing subgroups from low (<18.5kg/m2) to high body mass index (>30kg/m2), sensitivity increased from 55.6 to 67.8%, false positive rate from 5.2 to 11.5% and positive predictive value from 32.1 to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4kg), and of these 1058 (40.9%) were large for gestational age (>90th centile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized compared to uncustomized standards for low body mass index (<18.5; diagnostic odds ratio 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ration 16.2 vs 8.8). Late third trimester ultrasound estimation of fetal weight for any indication has good ability to identify and predict large for gestational age at birth, and improves with the use of a customised standard. Detection rate is better when ultrasound is performed for a suspected large fetus, however at the risk of higher false positive diagnosis. Our results provide information for women and clinicians to aid antenatal decision making about birth of a fetus suspected of being large for gestational age.

Polyhydramnios associated with rare genetic syndromes: two case reports

BackgroundWe present two genetic causes of polyhydramnios that were challenging to diagnose due to their rarity and complexity. In view of the severe implications, we wish to highlight these rare genetic conditions when obstetricians consider differential diagnoses of polyhydramnios in the third trimester.Case presentationPatient 1 is a 34-year-old Asian woman who was diagnosed with polyhydramnios at 28 weeks’ gestation. First trimester testing, fetal anomaly scan, and intrauterine infection screen were normal. Subsequent antenatal ultrasound scans revealed macroglossia, raising the suspicion for Beckwith–Wiedemann syndrome. Chromosomal microarray analysis revealed a female profile with no pathological copy number variants. The patient underwent amnioreduction twice in the pregnancy. The patient presented in preterm labor at 34 weeks’ gestation but elected for an emergency caesarean section. Postnatally, the baby was noted to have a bell-shaped thorax, coat hanger ribs, hypotonia, abdominal distension, and facial dysmorphisms suggestive of Kagami–Ogata syndrome. Patient 2 is a 30-year-old Asian woman who was diagnosed with polyhydramnios at 30 weeks’ gestation. She had a high-risk first trimester screen but declined invasive testing; non-invasive prenatal testing was low risk. Ultrasound examination revealed a macrosomic fetus with grade 1 echogenic bowels but no other abnormalities. Intrauterine infection screen was negative, and there was no sonographic evidence of fetal anemia. She had spontaneous rupture of membranes at 37 + 3 weeks but subsequently delivered by caesarean section in view of pathological cardiotocography. The baby was noted to have inspiratory stridor, hypotonia, low-set ears, and bilateral toe polysyndactyly. Further genetic testing revealed a female profile with a pathogenic variant of the GLI3 gene, confirming a diagnosis of Greig cephalopolysyndactyly syndrome.ConclusionThese cases illustrate the importance of considering rare genetic causes of polyhydramnios in the differential diagnosis, particularly when fetal anomalies are not apparent at the 20-week structural scan. We would like to raise awareness for these rare conditions, as a high index of suspicion enables appropriate counseling, prenatal testing, and timely referral to pediatricians and geneticists. Early identification and diagnosis allow planning of perinatal care and birth in a tertiary center managed by a multidisciplinary team.

Transvaginal sonographic diagnosis of caesarean scar ectopic pregnancy: A case report

We report a case of scar ectopic pregnancy which is the rarest type of all ectopic pregnancies. We need to diagnose &amp; treat this condition in the early weeks of pregnancy to avoid the complication. This case of Caesarean scar ectopic pregnancy (CSEP) was diagnosed during an antenatal ultrasound scan, at six weeks of pregnancy. An ultrasound scan of this case revealed the gestation sac in the lower uterine segment at the previous caesarean scar.

A Neonate with Diamond-Shaped Yellowish Scaling of the Skin: A Case Report on Harlequin Ichthyosis

Harlequin Ichthyosis is an extremely rare genetic disorder of the skin with a mortality rate of 44%. It is inherited in an autosomal recessive pattern, pointing towards the role of consanguinity among parents as a contributing factor. We present a unique case of a Harlequin baby whose parents' marriage was nonconsanguineous with no family history of the disease on either side. The antenatal ultrasound scans were normal as well with oligohydramnios as the only prominent feature a week before delivery. Hence, leading to a low suspicion and delayed diagnosis of an already extremely fatal condition. A two-hour-old female baby presented with generalized yellow scales and fissures covering the body in a diamond-like pattern, along with ectropion, eclabium, abnormal digits, clubfeet, and contractures in the extremities. The chest and abdomen were covered with thick scales as well, but the ear and anal canal were patent. Based on these findings, a clinical diagnosis of Harlequin Ichthyosis was made. Supportive management with a multi-disciplinary approach was started, focusing on temperature regulation, nutrition supplementation, eye &amp; skin care, and pain control. However, the next day the patient developed respiratory distress and was put on CPAP. Due to skin hyperkeratinization, intravenous access could not be maintained. Instead, umbilical catheterization was used as a source of nutrition and medicines. Her condition kept deteriorating, leading to tachycardia, tachypnea, and sudden onset of apnea, eventually leading to a need for intubation. Being aware of the associated complications and poor prognosis, the parents decided to withdraw supportive care, leading to death soon after. Since the characteristic findings on antenatal scans are usually not seen until the last trimester, we emphasize the importance of early confirmatory diagnosis via genetic screening, as delayed management leads to even worse outcomes. Additionally, we also recommend counselling the parents for future pregnancies due to the recurrence of the disease.

Use of Microsoft Power BI to display pregnancy related performance statistics within NHS trusts

ObjectiveWe wanted to create a dashboard that allowed midwives and doctors to monitor the performance of their NHS Trust by viewing the statistics relating to their performance in identifying babies at risk due to not growing well in the womb (small for gestational age, SGA), the single largest cause of stillbirths and subject to national guidelines and reporting requirements. Antenatal detection of SGA allows clinicians to undertake further investigations and plan for a timely delivery.&#x0D; MethodThe use of Power BI instead of a solution requiring software development allowed the data analysis team to be in control of creating the application and facilitate a streamlined updating process. We used the dashboard feature, dropdowns and radio buttons to display statistics relating to the rate of identification of SGA at antenatal ultrasound scan as a proportion of all babies that are SGA at birth (sensitivity) as well as false positivity. The dashboard is contained within the web-based application to monitor growth during antenatal care. Applying the row level security feature with DAX formula, we were able to personalise the report for each Trust depending on who logged into the web-app.&#x0D; ResultsThe application facilitates monitoring performance of the service in real time, longitudinally by month, quarter and year as well benchmark cross-sectionally against network/regional and national averages. The dashboard lets clinicians access their information in a clear and secure manner without the need for a separate link. The ready availability of data allows Trusts to enact policies to improve their performance and ultimately prevent avoidable deaths, and has contributed to the year on year decline in stillbirth rates in units that have been running this application.&#x0D; ConclusionDevelopment of this dashboard has resulted trusts being more aware of their own data to promote improvements in antenatal care.

999 The Incidence of Foetal Scoliosis and the Chances of Successful Delivery

Abstract Aim Foetal scoliosis can be detected on antenatal ultrasound and may be associated with other spinal abnormalities such as hemivertebrae. Little is known regarding its incidence and implications. Method The computerised foetal medicine ultrasound database at a tertiary hospital was retrospectively analysed using the search terms “spine” and “scoliosis”, between 1997 and 2021. The reports were manually reviewed, and patients removed that showed no abnormalities. Demographics of the mother, pregnancy and outcome data were collated. Results During the 24-year study period, 600,000 antenatal ultrasound scans were available. A duplicate rate was calculated, resulting in a total population of 378,000 foetuses. Initial results yielded 195 scans, and after removal of duplicates and manual checking of reports, there were 123 cases of confirmed spinal deformities, with an incidence of approximately 0.33 per 1000 foetuses (1 in 3000). Of the 123, there were 59 (48%) that reached term and 64 (52%) which did not. Of those that survived to term, 36/59 (61%) had normal development and no other concerns. The remaining patients had other non-fatal abnormalities, including VACTERL association in 5 cases (8.4%). Of those that did not survive, only one patient did not have other significant abnormalities. In most cases, there were multiple significant abnormalities, and the decision was taken for termination of pregnancy (52 cases, 81%). Conclusions This study represents the largest database review of antenatal scans for spinal abnormalities. The incidence of foetal spinal deformity is approximately 1 in 3000, and prognosis is generally determined by the presence of other significant abnormalities.

Incidental finding of Posterior Urethral Valve during routine antenatal ultrasound: Diagnostic imaging case report in Botswana

Medical ultrasound is a particularly useful imaging method used in the diagnosis of urinary foetal anomalies. One such foetal anomaly is the posterior urethral valve (PUV), which is a congenital malformation of the male urethra occurring early in gestation life. PUV is a common cause of obstructive uropathy in males and foetal death during pregnancy. We report from a medical imaging perspective on a rare and high-risk case of a PUV detected during routine antenatal ultrasound imaging in Botswana. The first scan performed at 16 weeks of gestation age was unremarkable. However, subsequent antenatal ultrasound scans at and after 20 weeks demonstrated bilateral hydronephrosis, distended ureters, and a urinary bladder which gradually increased with the gestation age. There was also a corresponding reduction in amniotic fluid and foetal movements. As a result of these complications, the pregnancy was classified as a “high-risk.” At 30 weeks, spontaneous labour occurred and a fresh still birth was delivered.

Fetal and neonatal outcomes of pregnancies with antenatal ultrasound findings

Abstract Background: Detection of variations or abnormalities in antenatal fetal ultrasound scans helps in planning further follow-up and intervention. Sometimes, finding soft markers could alarm anxious families. Systematic studies on clinically relevant outcomes would aid in prognostication, allay anxieties and help in designing reporting templates. Methodology: This retrospective study included pregnancies that were flagged with any fetal ultrasound finding by the high-risk obstetrics department during the study period. We studied the proportion of those with any one of adverse fetal/neonatal outcomes (AFNO): (a) fetal loss (b) neonatal death; or who required (c) surgical intervention (d) neonatal intensive care support (e) periodic follow-up related to the finding. A descriptive analysis of findings and specific AFNO were also conducted. Results: Of 1495 scans, 495 had at least 1 ultrasound finding. Complete details of primary outcome were available for 360 pregnancies; 60 (16.7%) had AFNO. Most common were cardiac echogenic focus (19.5%), prominent cavum vergae (12.6%), urinary tract dilatation (9.3%), and choroid plexus cyst (8.9%). The above-isolated findings had good outcomes (AFNO in 4.6%). Overall, AFNO were noted in 12.7% of those with single findings. Brain anomaly, omphalocele, and hydrops had poor outcomes. With 2 and 3 findings in combinations, 22.1% and 44.4% had AFNO, respectively. Conclusions: AFNO were noted in 16.7% of those with any fetal ultrasound finding. When expectant families are informed about specific isolated soft markers (echogenic cardiac focus, cavum vergae, echogenic bowel, hypoplastic nasal bone, choroid plexus cyst, single umbilical artery) clinicians may also reassure the low association of AFNO.

Soluble Vascular Adhesion Protein 1 (sVAP-1) as a biomarker for pregnancy complications: A pilot study.

Vascular adhesion protein 1 (VAP-1) has been implicated in a wide range of clinical conditions. Moreover, serum levels are associated with disease prediction and progression in several clinical studies. There is a paucity of data on VAP-1 and pregnancy. Given the emerging role of VAP-1 in pregnancy, the aim of this study was to examine sVAP-1 as an early biomarker of pregnancy complications, especially hypertension during pregnancy. The objectives of the study are to associate sVAP-1 levels with other pregnancy complications, patient demographics and blood tests performed throughout pregnancy. We conducted a pilot study in a cohort of pregnant women (gestational week lower than 20 at the time of recruitment) attending their first antenatal ultrasound scan at the Leicester Royal Infirmary (LRI, UK). Data were both prospectively generated (from blood sample analysis) and retrospectively collected (from hospital records). From July and October 2021, a total of 91 participants were enrolled. Using ELISA (enzyme-linked immunosorbent assay), we found reduced serum levels of sVAP-1 in pregnant women with either pregnancy induced hypertension (PIH) (310 ng/mL) or GDM (366.73 ng/mL) as compared to controls (427.44 ng/mL and 428.34 ng/mL, respectively). No significant difference was found between women with FGR compared to controls (424.32 ng/mL vs 424.52 ng/mL), and patients with any pregnancy complications compared to healthy pregnancies (421.28 ng/mL vs 428.34 ng/mL). Further studies are needed to establish whether or not sVAP-1 might be considered as an early, non-invasive, and affordable biomarker to screen women who will develop PIH or GDM. Our data will aid sample size calculations for such larger studies.

ANTENATAL UMBILICAL CORD COILING INDEX AS A PREDICTOR OF PREGNANCY OUTCOME

Introduction: Negative pregnancy outcomes, such as stillbirth, neonatal mortality, premature delivery, low birth weight, and admission to the neonatal intensive care unit (NICU), are linked to anomalies in the umbilical cord, such as the nuchal cord, marginal cord insertion, and aberrant cord coiling. Not many studies throw insight into this topic from South Indian settings. Objective: To investigate the role of the antenatal umbilical cord coiling index (AUCCI) in predicting adverse pregnancy outcomes. Methods: This is a cross-sectional study of 200 pregnant women who underwent antenatal ultrasound scans with ≥ 28 weeks of gestation with singleton live pregnancy who attended the obstetrics department. The AUCCI was measured as the ratio of the total number of coils in the umbilical cord to its length. The primary outcome was to nd the association between AUCCI and adverse pregnancy outcomes, including both maternal and fetal outcomes. Results: The mean AUCCI was 24 ±0.10, we categorised AUCCI &lt;0.42 as hypocoiled, 0.42 – 0.59 as normocoiled and more than equal to 60 as hypercoiled based on distribution. We also observed a signicant association between AUCCI and PPH, PROM, APGAR score, NICU admission, and low birth weight. (p-value &lt;0.05) Conclusion: The antenatal umbilical cord coiling index is a simple and noninvasive tool that can be used to predict adverse pregnancy outcomes. The lower the AUCCI, the higher the risk of adverse pregnancy outcomes

Novel variant of TMEM231 in Meckel syndrome: a case report

A 34-year-old woman underwent routine antenatal ultrasound scanning at 17 weeks gestation which identified multiple fetal abnormalities including severe oligohydramnios, growth restriction, occipital encephalocele, short and bowed long bones, bilateral enlarged multicystic kidneys and an absent bladder. As the findings were highly suspicious for a lethal fetal ciliopathy, the patient received counselling and elected for a medical termination of pregnancy at 19 weeks. Autopsy confirmed the imaging findings, additionally demonstrating low set ears, micrognathia, a broad nasal bridge, polysyndactyly and bilateral hypoplastic lungs.

Classification of Ventriculomegaly and its Associated Findings using Antenatal Ultrasound Scan at a Tertiary Care Hospital: Andhra Pradesh, India: A Retrospective Descriptive Study

Introduction: Foetal Ventriculomegaly (VM) is defined as the enlargement of the lateral ventricles in the developing foetal brain. The measurement of foetal cerebral lateral ventricles’ size is routinely recommended as part of the second-trimester foetal scan to screen for anomalies. VM can occur due to obstruction of the Cerebrospinal Fluid (CSF) tract, absorption disorders, inadequate brain development, or excessive CSF production. Aim: To classify VM based on severity to differentiate between isolated and non isolated VM. Materials and Methods: A retrospective descriptive study was conducted in the Department of Radiology at PESIMSR, Andhra Pradesh, India., a tertiary medical hospital, from April 2018 to April 2021. Cases were selected from computer records showing a diagnosis of hydrocephalus or foetal VM in patients who underwent the Ultrasound (US) anomaly scan. VM was defined as a lateral ventricle width of ≥10 mm. Foetal VM was classified, and associated CNS and extracranial abnormalities and their details were collected. Descriptive statistics were used, and results were expressed in terms of frequency and percentage. Results: The VM was observed in 91 foetuses, with mild VM in 59 foetuses (64%), moderate VM in 14 foetuses (15.2%), and severe VM in 18 foetuses (19.5%). The median age at diagnosis was 26.5 weeks. Isolated mild VM was seen in 26 cases (44%), and it was associated with other abnormalities in 33 cases (56%). Isolated moderate VM was observed in four cases (28.5%), while 10 cases (71.4%) were associated with other abnormalities. Isolated severe VM was seen in (33.3%) 6, and it was associated with abnormalities in 12 cases (66.6%). The most common associated abnormalities were foetal growth restriction (15 cases), absent cavum septum pellucidum (eight cases), and open spina bifida, Arnold-Chiari malformation (eight cases). Conclusion: Ultrasound is a sensitive tool for detecting VM. Once VM is diagnosed, a detailed examination of the fetus should be conducted to evaluate other CNS and non CNS anomalies, thereby differentiating isolated from non-isolated VM, as the prognosis may vary. This information will be valuable for counseling patients.

Efficacy of Yoga therapy as Non-pharmacological management in Women with High-risk Pregnancy: A Single Case Report

This present case study is about a High-risk Pregnancy that includes Pregnancy-induced Hypertension and an abnormal range of Uterine artery pressure, 22 years old female consulted to Gynaecologist for a complaint of missing menstrual cycle. They were diagnosed with Pregnancy positive with the help of a urinary pregnancy test (UPT). In the 13th week, as per a routine follow-up gone for an antenatal ultrasound scan report shows a There is a single live intrauterine gestation with an abnormal range of Right uterine artery PI and left uterine artery PI and diagnosed as a high-risk pregnancy. After a week, time patient has given a blood sample for a thyroid profile. Reports revealed that TRI IODO THYRONINE (T3)-2.13H and THYROXINE (T4) 21.9 H are in the higher range and noticed blood pressure range in higher side diagnosed as Pregnancy induced Hypertension (PIH) High-risk pregnancy will affect both mother and fetus in its way, on mother side, it increases blood pressure called preeclampsia and affects fetal growth result in Intrauterine growth restriction, premature birth, Stillbirth (1). After the 13th week of Pregnancy diagnosed with high-risk Pregnancy, patients are introduced to yoga therapy, including Asana, Pranayama, Meditation, etc., for three days a week regularly till the date of delivery and followed case till delivery. Yoga helps normalize blood pressure and impacts pregnancy outcomes as a standard range of APGAR score in babies and healthy birth weight. Does not show any complications of High-risk Pregnancy on the maternal and fetal side.

CONGENITAL UTERINE ANOMALY-BICORNUATE UTERUS WITH SUCCESSFUL PREGNANCIES OUTCOMES IN A TERTIARY HOSPITAL, SOUTHERN NIGERIA: CASE SERIES

Bicornuate uterus, a class IV Mullerian anomaly results from impairment in the fusion of the Mullerian duct. It is associated with both normal and many obstetric complications. We present two rare cases of bicornuate uterus with successful pregnancy outcomes among Nigerian ladies. The diagnoses of the bicornuate uterus were made incidentally during a routine antenatal ultrasound scan in their first pregnancies. These were confirmed intraoperatively and the patients were notified.&#x0D; In the first case, the foetal head occupied the cavity of the left horn and the breech in the cavity of the large right horn while in the second case, the right horn was empty and the foetus was in the left horn. These women with bicornuate uterus carried their pregnancies to term and had elective repeat caesarean sections with favourable foeto-maternal outcomes. The mothers and their babies are alive and doing well.&#x0D; Overall, the ladies had two and four successful pregnancy outcomes respectively. Women with a bicornuate uterus can achieve successful pregnancy outcomes despite the obstetric challenges of the anomaly. Thus, the index cases highlight that it is practically safe to forgo metroplasty in bicornuate uterus, in particular, asymptomatic women that had achieved successful pregnancies.

Prevalence of Intrauterine Growth Retardation on Antenatal Ultrasound Scan in Lahore, Pakistan

Fetal growth retardation is described as infants whose weights are much less than expected. Population based norms are used to categorize abnormal growths. The objective of the study was to determine the frequency of intrauterine growth retardation on antenatal ultrasound scan. It was an observational descriptive study conducted at the Radiology Department of Fatima Memorial Hospital, Shadman Lahore. Patients visited the Ultrasound Department for Obstetric scan. The study was conducted in 6 months from January to June in 2022. The sample size of 87 was calculated for study with expected rate of 9% of pregnancies resulted in intrauterine growth retardation at 5% level of significance at 5% margin of error. The study included pregnant females in third trimesters of pregnancy. The data was analyzed using SPSS version 20. A total of 87 obstetric ultrasounds were performed during the study period. The mean age of the patients was 28.69 ±4.46 years with age range 20-42. The 87 included patients showed mean gestational age 35.29 ±2.50 weeks. The mean biparietal diameter was 8.69±0.57 cm and abdominal circumference was 29.72±3.03 cm. The mean fetal body weight is 2.52±0.59 kg. The frequency of intrauterine growth retardation was 10.3%. Fetal biometry, biophysical profile and Doppler studies were helpful in the diagnosis of intrauterine growth retardation and evaluation of ultrasound parameters in third trimester.

Midwife‐Led Ultrasound Scanning to Date Pregnancy in Malawi: Development of a Novel Training Program

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach.

Blood Pressure Measurement in Pregnancy – Interarm Differences and The Necessity of Multiple Consecutive Measurements

Objective: To investigate multiple blood pressure measurements and interarm differences in a pregnant population. Method: Pregnant women attending routine antenatal ultrasound scans in gestational weeks 11-13 or week 20 had three consecutive blood pressure measurements on each arm conducted according to international guidelines. Mean and mean difference between the 1st measurement (BP-A) and 2nd + 3rd measurements combined (BP-B) as well as between right and left arm, respectively, were calculated and compared by paired t-test. Bland-Altman plots illustrate means and mean-differences of systolic and diastolic pressure between BP-A and BP-B. Results: One-hundred women were included. Mean systolic, diastolic and arterial blood pressure for BP-A were 112.1 mmHg, 70.6 mmHg and 84.4 mmHg, respectively, while mean BP-B were 109.8 mmHg, 69.2 mmHg and 82.8 mmHg. Mean differences in systolic, diastolic and mean arterial pressure (MAP) between BP-A and BP-B were 2.5 mmHg (P&lt;0.001, 95% Confidence interval (CI) 1.7;3.2), 1.5 mmHg (P&lt;0.001, 95% CI 1.0;2.0) and 1.8 mmHg (P&lt;0.001, 95% CI 1.4;2.2). Mean interarm differences in systolic, diastolic and MAP were 3.1 mmHg (P&lt;0.001, 95% CI 1.9;4.3), 0.75 mmHg (P=0.019, 95%CI 0.1;1.4) and 2.4 mmHg (P=0.01, 95% CI 0.6;4.2). Conclusion: In pregnancy, the first blood pressure measurement of three consecutive is significantly higher than the following two. Blood pressure on the right arm is significantly higher compared to the left arm. International guidelines on blood pressure measurements should apply to pregnant women.

Incidental Finding of Posterior Urethral Valve during Routine Antenatal Ultrasound: Diagnostic Imaging Case Report in Botswana

Medical ultrasound is a particularly useful imaging method used in the diagnosis of urinary fetal anomalies. One such fetal anomaly is the posterior urethral valve (PUV), which is a congenital malformation of the male urethra occurring early in gestation life. PUV is a common cause of obstructive uropathy in males and fetal death during pregnancy. We report from a medical imaging perspective on a rare and high-risk case of a PUV detected during routine antenatal ultrasound imaging in Botswana. The first scan performed at 16 weeks of gestation age was unremarkable. However, subsequent antenatal ultrasound scans at and after 20 weeks demonstrated bilateral hydronephrosis, distended ureters, and a urinary bladder which gradually increased with the gestation age. There was also a corresponding reduction in amniotic fluid and fetal movements. As a result of these complications, the pregnancy was classified as a “high-risk.” At 30 weeks, spontaneous labour occurred, and a fresh still birth male fetus was delivered.