Early Ultrasound Screening Research Articles

The importance of a late first trimester placental sonogram in patients at risk of abnormal placentation.

Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality. This report highlights risk factors, early diagnostic findings and complications associated with placenta accreta, and the role of first trimester sonography in diagnosis. Case. A 38-year-old pregnant woman, G2P1L1 with history of one previous Caesarean section, presented with vaginal bleeding at 13 weeks' gestation. Ultrasound examination was highly suspicious of placenta previa with accreta. During an earlier 12-week scan for nuchal translucency measurement, the placenta was suboptimally visualized. She was counselled regarding potential maternal and fetal complications as well as management options. At 33 weeks' gestation Caesarean hysterectomy was performed due to vaginal bleeding. Conclusion. Early ultrasound screening in high-risk patients may be advantageous in order to identify placenta accreta and conduct appropriate patient counseling regarding risks and management options.

Genetic and environmental effects on carotid flow velocities: An international twin study

IntroductionAltered carotid blood flow velocities (CFV) have a complex background but the underlying genetic contribution is still unclear. We sought to evaluate the influence of genetics, shared and unshared environmental components on individual differences of CFV. Methods193 healthy twin pairs, 126 monozygotic (MZ) and 67 dizygotic (DZ) (mean age 53 ± 14 years) recruited in Italy, in the United States and in Hungary underwent bilateral color-coded Doppler flow assessment of the common carotid artery (CCA) and of the internal carotid artery (ICA) in order to assess the peak systolic (PSV) and end diastolic (EDV) velocities. Means of bilateral CFV values were used in the analysis. ResultsAge- and country-adjusted intra-class correlations were higher in monozygotic than in dizygotic pairs for mean PSV of the ICA indicating a heritability of 63%. Unique environmental factors contributed to 37% of ICA PSV. With regards to the mean PSV and EDV of the CCA, and EDV of the ICA, heritability analysis indicated no discernible role for genetic components, while the contributions of shared and unshared environmental factors ranged between 56% and 63%, and between 37% and 44% adjusted for age and country, respectively. Mean ICA/CCA ratio was driven by unique environmental factors (82%) with modest heritability (18%). ConclusionsOur study showed that the heritability of ICA PSV and ICA/CCA ratio is moderate, while the findings do not support heritability of other investigated CFV values. Environmental effects account for a moderate to major portion of the variance. These findings support the value of early ultrasound screening as well as the prevention of modifiable environmental factors in case of altered carotid flow velocities.

Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil

To establish reference values for the first trimester uterine artery resistance index (UtA-RI) and pulsatility index (UtA-PI) in healthy singleton pregnant women from Northeast Brazil. A prospective observational cohort study including 409 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11 - 14 weeks of gestation was performed. The patients responded to a questionnaire to assess maternal epidemiological characteristics. The left and right UtA-PI and UtA-RI were examined by color and pulsed Doppler by transabdominal technique and the mean UtA-PI, mean UtA-RI and the presence of bilateral protodiastolic notching were recorded. Quartile regression was used to estimate reference values. The mean ± standard deviation UtA-RI and UtA-PI were 0.7 ± 0.1 and 1.5 ± 0.5, respectively. When segregated for gestation age, mean UtA-PI was 1.6 ± 0.5 at 11 weeks, 1.5 ± 0.6 at 12 weeks, 1.4 ± 0.4 at 13 weeks and 1.3 ± 0.4 at 14 weeks' gestation and mean UtA-RI was 0.7 ± 0.1 at 11 weeks, 0.7 ± 0.1 at 12 weeks, 0.6 ± 0.1 at 13 weeks and 0.6 ± 0.1 at 14 weeks' gestation. Uterine artery bilateral notch was present in 261 (63.8%) patients. We observed that the 5th and 95th percentiles of the UtA-PI and UtA-RI uterine arteries were 0.7 and 2.3 and, 0.5 and 0.8, respectively. Normal reference range of uterine artery Doppler in healthy singleton pregnancies from Northeast Brazil was established. The 95th percentile of UtA-PI and UtA-RI values may serve as a cut-off for future prediction of pregnancy complications studies (i.e., pre-eclampsia) in Northeast Brazil.

FRI0315 Congenital heart block in a cohort of pregnant women with anti-ro/ssa and/or anti-la/ssb antibodies.

BackgroundMaternal autoimmune-mediated fetal heart disorders include a wide spectrum of conduction disturbances that can appear in fetuses of pregnant women with systemic autoimmune diseases, being congenital heart block (CHB) one...

P30.05: Diagnosis of placenta accreta in early pregnancy: case report and review of literature

Placenta accreta is an obstetric condition with management challenges and significant perinatal morbidity and mortality. The incidence has been rising in developing countries due to increased rates of cesarean section. We report a case of a 13 week gestation who had had a previous cesarean section. She presented at emergency room with vaginal bleeding and suspicion of incomplete abortion. Obstetric Ultrasound showed a live fetus and anterior placenta previa with sonographic findings of disruption of the placental-uterine interface, compatible with placenta accreta. After extensive counselling regarding adverse perinatal outcomes, the pregnancy is ongoing and the outcome will be reported. A few cases of early diagnosis of placenta accreta have been reported in the literature. Many of those cases, the Ultrasound were performed due to early symptoms such as vaginal bleeding or abdominal pain. Complication of placenta accreta has been a dilemma management due to serious consequences with maternal and fetus life threatening. Hysterectomy, uterine rupture, excessive blood loss and coagulopathy have been reported in the first trimester. We have reviewed the literature from July 1995 to June 2009 of placenta accreta diagnosed at first trimester of pregnancy. Risk factors, diagnostic ultrasound findings, management, complications and pregnancy outcome are discussed in this article. Given high incidence of complications of placenta accreta, we believe that it is feasible and recommended early ultrasound screening in patient with high risk for placenta accreta. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Pitfalls in graf's method for early ultrasound screening of hip displasia

The ultra sound screening of baby`s hip is one of the most valuable method for early diagnosis of congenital or developmental hip dysplasia. Graf`s method is a popular world wide, having thousands of follow ers. Every observer must know as the normal ultrasound anatomy, as the hip patho ogy images. He also must be aware of possible errors, coming from the improper use of devices (console softwear options and transducers) and some image distortions, resulted by the `tilt` effect. Thus the method will avoid possibility to give wrong diagnosis and to mis lead as the observer as all other specialists, who care for the baby`s health. Scripta Scientifica Medica 2010;42(1):25-30

WITHDRAWN: Ultrasound for fetal assessment in early pregnancy.

Advantages of early pregnancy ultrasound screening are thought to be more accurate calculation of gestational age, earlier identification of multiple pregnancies, and diagnosis of non-viable pregnancies and certain fetal malformations. The objective of this review was to assess the use of routine (screening) ultrasound compared with the selective use of ultrasound in early pregnancy (ie before 24 weeks). The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (up to June 2001) were searched. Adequately controlled trials of routine ultrasound imaging in early pregnancy. One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. Nine trials were included. The quality of the trials was generally good. Routine ultrasound examination was associated with earlier detection of multiple pregnancies (twins undiagnosed at 26 weeks, odds ratio 0.08, 95% confidence interval 0.04 to 0.16) and reduced rates of induction of labour for post-term pregnancy (odds ratio 0.61, 95% confidence interval 0.52 to 0.72). There were no differences detected for substantive clinical outcomes such as perinatal mortality (odds ratio 0.86, 95% confidence interval 0.67 to 1.12). Where detection of fetal abnormality was a specific aim of the examination, the number of terminations of pregnancy for fetal anomaly increased. Routine ultrasound in early pregnancy appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible. However, the benefits for other substantive outcomes are less clear.

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Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population

To establish reference values for the first-trimester uterine artery (UtA) pulsatility index (PI) and to investigate the role of UtA Doppler in the early prediction of hypertensive disorders and their associated complications in an unselected Mediterranean population. A prospective study including 1091 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11-14 weeks of gestation was performed. The left and right UtA were examined by color and pulsed Doppler transvaginally. The mean PI and the presence of bilateral protodiastolic notching were cross-sectionally recorded. Reference ranges were calculated and the pregnancies were followed for occurrence of pre-eclampsia, gestational hypertension, intrauterine growth restriction, placental abruption and stillbirth. The sensitivity and predictive values of a mean UtA-PI>95th percentile and the presence of bilateral notching in the prediction of these pregnancy complications were calculated. A total of 999 women were finally included. Both the mean UtA-PI and the prevalence of bilateral notches showed a significant linear decrease between 11 and 14 weeks' gestation. Sixty-seven (6.7%) pregnancies developed at least one of the formerly described complications, including 22 (2.2%) cases of pre-eclampsia and 37 (3.7%) cases with intrauterine growth restriction. Compared with women with a normal outcome, complicated pregnancies showed a significantly higher mean PI (2.04 vs. 1.75; P<0.05, t-test) and a higher prevalence of bilateral notching (58% vs. 41%; P<0.05, Chi-square test). Using the 95th percentile in mean UtA-PI as a cut-off, 23.9% (95% CI, 13.7-34.1) of complicated pregnancies and 30.8% (95% CI, 5.68-55.85) of severe cases were identified. Our results suggest that pregnancies with an increased risk of developing hypertensive disorders and related complications already have an abnormally increased UtA-PI in early pregnancy. However, the use of a single uterine Doppler measurement for screening purposes in unselected early pregnancy populations has limited clinical value. The use of UtA-PI combined with other screening tests needs to be determined by further investigation.

The GP's role in maternity care

In an Editorial in this issue, Westin and Bakketeig bring up the important question of whether uncritical use of ultrasound scanning in pregnancy can imply potential harm to the foetus. The Editorial evoked discussion among the national editors of this journal concerning the role of general practitioner in relation to maternity care. In the Nordic countries, as well as widely elsewhere, the care for healthy, pregnant women is generally organised within a primary health care setting. There are three main professions responsible for these preventive activities: general practitioners, midwives and gynaecologists. In Sweden, pregnancy care is usually organised in separate maternity units staffed mainly by midwives. Other countries organise primary clinical care and preventive care more or less under the same roof, served by a team of different professions. Primary care professionals are usually responsible for referring expectant women to routine ultrasound screening. In some instances, there is also ultrasound equipment at the local health care centre. In Iceland, where there is no referral system, a large number of pregnant women choose to consult a privately practising gynaecologist, often as early as in gestational weeks 7/9. These gynaecologists usually have ultrasound instruments in their office and will thus perform a scan to certify the presence of a vital embryo. This opportunity to experience ‘‘a first encounter’’ with the child-to-be could readily become part of the culture surrounding pregnancy. Why wait for weeks in uncertainty when a scan can tell immediately whether the foetus looks alive and well? During this first appointment, an Icelandic gynaecologist is likely to inform the pregnant women about the possibility to have a next ultrasound examination in pregnancy weeks 11/14 (early ultrasound screening). This is a scan designed to detect chromosomal aberrations and certain other foetal anomalies. It usually does not replace ultrasound screening in weeks 18/20, which has been a routine in many countries for 15/20 years. In a recent Editorial in SJPHC (1), Getz stated that primary health care personnel should not regard ultrasound in pregnancy as a specialist topic belonging solely within the sphere of obstetricians. As GPs, we want the health care system to deliver optimal care for pregnant women and their unborn children. When applying medical technology on a large scale in a preventive setting, it is paramount to ascertain that it does not entail the potential for unintended damage. Primum non nocere / first if all, do no harm.

Maternal anxiety and maternal–fetal attachment in women having early ultrasound screening for fetal abnormality

In order to evaluate the impact of early ultrasound screening for fetal abnormality, it is imperative that the psychological impact of screening is assessed. The aim of this study was to determine the effect of a normal early scan on maternal–fetal attachment and anxiety at two stages of pregnancy. Two hundred and thirty-five women participating in a large randomised trial of ultrasound screening at 10–14 weeks’ gestation were recruited; 122 from the scan group with a structurally normal fetus and a low risk [> 1 : 300 of Down syndrome (based on nuchal translucency)] and 113 from the control group. Participants completed a postal questionnaire, incorporating the Hospital Anxiety and Depression Scale-Anxiety Subscale (HAD-A) and the Maternal Fetal Attachment Scale (MFAS), at 1 week after randomisation and at 30 weeks of pregnancy (see Table). All women had a normal 19-week anomaly scan.

Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women's views.

Background Advantages of early pregnancy ultrasound screening are considered to be more accurate calculation of gestational age, earlier identification of multiple pregnancies, and diagnosis of non-viable pregnancies and certain fetal malformations. Objective The objective of this review was to assess the use of routine (screening) ultrasound compared with the selective use of ultrasound in early pregnancy (i.e. before 24 weeks). Search strategy The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (up to July 1998) were searched. Selection criteria Adequately controlled trials of routine ultrasound imaging in early pregnancy. Data collection and analysis One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. Main results Nine trials were included. The quality of the trials was generally good. Routine ultra- sound examination was associated with earlier detection of multiple pregnancies (twins undiag- nosed at 26 weeks, OR 0.08; 95% CI, 0.04 to 0.16) and reduced rates of induction of labour for post- term pregnancy (OR 0.61; 95% CI, 0.52 to 0.72). There were no differences detected for substantive clinical outcomes such as perinatal mortality (OR 0.86; 95% CI, 0.67 to 1.12). When detection of fetal abnormality was a specific aim of the exam- ination, the number of terminations of pregnancy for fetal anomaly increased. Reviewers’ conclusions Routine ultrasound in early pregnancy appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible. However, the benefits for other substantive outcomes are less clear.

Ultrasound for fetal assessment in early pregnancy.

Advantages of early pregnancy ultrasound screening are thought to be more accurate calculation of gestational age, earlier identification of multiple pregnancies, and diagnosis of non-viable pregnancies and certain fetal malformations. The objective of this review was to assess the use of routine (screening) ultrasound compared with the selective use of ultrasound in early pregnancy (ie before 24 weeks). The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (up to July 1998) were searched. Adequately controlled trials of routine ultrasound imaging in early pregnancy. One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. Nine trials were included. The quality of the trials was generally good. Routine ultrasound examination was associated with earlier detection of multiple pregnancies (twins undiagnosed at 26 weeks, odds ratio 0.08, 95% confidence interval 0.04 to 0.16) and reduced rates of induction of labour for post-term pregnancy (odds ratio 0. 61, 95% confidence interval 0.52 to 0.72). There were no differences detected for substantive clinical outcomes such as perinatal mortality (odds ratio 0.86, 95% confidence interval 0.67 to 1.12). Where detection of fetal abnormality was a specific aim of the examination, the number of terminations of pregnancy for fetal anomaly increased. Routine ultrasound in early pregnancy appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible. However the benefits for other substantive outcomes are less clear.

Antenatal Classification of Hydrops Fetalis

Among 12,572 pregnant women referred for ultrasound examination from 1985-1990, 76 fetuses had ultrasonographic findings of hydrops fetalis, ten immune and 66 nonimmune. Fetuses with cystic hygroma (20), heart defects or arrhythmias (13), or other congenital anomalies (15) accounted for the majority of the nonimmune cases. Antenatal chromosomal studies were available in 42 fetuses with nonimmune hydrops, of which 14 (34%) were abnormal with seven monosomes and six trisomies. Seventeen cases of hydrops (22%) were classified as idiopathic because they had no recognizable etiology. It is concluded that: 1) The ultrasonographic incidence of fetal hydrops in referral centers can be as high as one in 165 pregnancies; 2) most cases of fetal hydrops are of the nonimmune type, which can occur in a low-risk population and can be detected with early second-trimester ultrasound screening; and 3) the complexity of this condition and the high rate of chromosomal abnormalities require referral to a high-risk center for evaluation and pregnancy management.

Evaluation of early third-trimester ultrasound screening for intrauterine growth retardation.

Ultrasound fetal biometry is widely used for detection of intrauterine growth retardation (IUGR). Since fetal growth is a dynamic process, studies estimating validity of ultrasound near term may not be applicable earlier in pregnancy. This study applied receiver operating characteristic (ROC) curve analysis to ultrasound biometric data obtained at 26-34 weeks gestation to predict fetuses destined to be IUGR at birth. In this method, the area under the curve (theta) is the index of performance. Sixty-nine (9%) of the 768 singleton infants studied were IUGR at birth. Ultrasound estimated fetal weight (theta = .793) and abdominal circumference (theta = .785) had equivalent performance, significantly better than head circumference (theta = .724) or femur length/abdominal circumference ratio (theta = .619). Performance was not as good as suggested by studies conducted within 2 weeks of delivery.

Early doppler ultrasound screening in prediction of hypertensive disorders of pregnancy

1198 nulliparous women were screened in early pregnancy (median 18 weeks' gestation) by the recording of doppler ultrasound waveforms from the uteroplacental circulation. After exclusions, the results of 1014 women were available for analysis; 118 (12%) of them had persistently abnormal waveforms on repeat ultrasound scans at 24 weeks and were taken to have a positive test result. Hypertension was significantly more frequent among those women than among women with normal doppler waveforms (29/118 [25%] vs 45/896 [5%]). In addition, hypertension in women with abnormal waveforms was more likely to be severe; 12 (10%) had proteinuria and 15 (13%) intrauterine growth retardation compared with 7 (0·8%) and 0, respectively, of those with normal waveforms. Overall, the test did poorly when assessed by standard statistical means. However, the sensitivity was high for hypertension associated with either proteinuria (63%) or intrauterine growth retardation (100%). The test is cheap, easy to carry out, and non-invasive, and it can be done in early pregnancy; it is therefore a useful means of identifying a high-risk group of pregnant women suitable for therapeutic intervention to reduce the incidence of hypertensive disorders and their complications.

Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term

International Journal of Gynecology & ObstetricsVolume 27, Issue 2 p. 316-316 Citations from the literature diseases in pregnancy Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term CJ Bochner, CJ BochnerSearch for more papers by this authorAL Medearis, AL MedearisSearch for more papers by this authorJ Williams III, J Williams IIISearch for more papers by this author CJ Bochner, CJ BochnerSearch for more papers by this authorAL Medearis, AL MedearisSearch for more papers by this authorJ Williams III, J Williams IIISearch for more papers by this author First published: October 1988 https://doi.org/10.1016/0020-7292(88)90065-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume27, Issue2October 1988Pages 316-316 RelatedInformation

Early Third-Trimester Ultrasound Screening in Gestational Diabetes to Determine the Risk of Macrosomia and Labor Dystocia at Term

Early Third-Trimester Ultrasound Screening in Gestational Diabetes to Determine the Risk of Macrosomia and Labor Dystocia at Term

Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term

The purpose of this study was to determine whether an early third-trimester fetal abdominal circumference measurement can be used in patients with gestational diabetes to predict the presence or absence of macrosomia and labor dystocia at term. The predictive accuracy of a 30- to 33-week abdominal circumference measurement was tested, using the ninetieth percentile as the discriminant point. The study consisted of 201 patients with gestational diabetes who maintained weekly fasting glucose levels less than 100 mg/dl and 2-hour postprandial glucose levels less than 120 mg/dl with dietary management alone. The predictive accuracy of a 30- to 33-week fetal abdominal circumference measurement was 96.4% for ruling out macrosomia and 56.3% for predicting macrosomia. Patients with fetal abdominal circumference measurements greater than the ninetieth percentile at 30 to 33 weeks had a significantly increased incidence of cesarean section for failure to progress, shoulder dystocia, and birth trauma, whereas patients with abdominal circumference measurements less than or equal to the ninetieth percentile were at no greater risk than the general population. These results suggest that patients with non-insulin-dependent gestational diabetes with fetal abdominal circumference measurements less than or equal to the ninetieth percentile at 30 to 33 weeks are not at increased risk for macrosomia, cesarean section, or birth trauma at term, as long as their weekly glucose testing remains within normal limits. Efforts to decrease the incidence of macrosomia and its attendant risks should focus on those gestational diabetic patients whose fetal abdominal circumference greater than the ninetieth percentile at 30 to 33 weeks.