Fetal Sonographic Examination Research Articles

Antiarrhythmic drugs-safety and efficacy during pregnancy.

When deciding on antiarrhythmic drug (AAD) treatment, athorough knowledge of the physiological adaptation processes that occur during pregnancy and their effect on metabolism and the efficacy of AAD is mandatory. Beyond the desired effects of AAD therapy, side effects can occur in pregnant women. Furthermore, potential harm to fetal development-depending on gestational age-needs to be considered. Athorough evaluation of potential risks opposed to expected benefits for mother and fetus should be carried out before initiation of AAD treatment. Regular maternal echocardiography and fetal sonographic examination during pregnancy under AAD treatment are advisable. If possible, serum concentrations of AAD should be measured on aregular basis. Due to electrolyte and volume imbalances after delivery, maternal monitoring is recommended for approximately 48 h under AAD therapy. Current guidelines are based on almost historic analyses, where AAD were often prescribed for other indications than rhythm disorders. In clinical practice, AAD predominantly used during pregnancy are intravenous adenosine for acute treatment of atrioventricular nodal dependent tachycardias, whereas betablockers, sotalol, and flecainide can be orally administered for long-term therapy.

Dandy-Walker Malformation: Prenatal sonographic diagnosis

The Dandy-Walker malformation is a rare congenital intracranial malformation that comprises of complete or partial agenesis of the cerebellar vermis, cystic dilatation of the 4th ventricle and an enlarged posterior fossa. Here we report a case of Dandy-Walker malformation detected incidentally during a routine fetal sonographic examination at 18 weeks of gestation. The couple decided termination of pregnancy, after adequate genetic counseling. Detailed postmortem examination revealed correlation between prenatal sonographic imaging and histopathological findings. This case report indicates the fact that fetal magnetic resonance imaging may not be necessary in diagnosis, especially when pregnancy termination is preferred.

Prenatal diagnosis of a large suprasellar arachnoid cyst

Arachnoid cysts represent 1% of all intracranial lesions and appear on the arachnoid membrane (subarachnoid space). The etiology and pathogenesis of arachnoid cysts remain unclear and in their majority they are asymptomatic. Due to the developmental origin of arachnoid cysts, these formations can be identified on prenatal fetal imaging. In this report we presented a case of an enlarged suprasellar arachnoid cyst detected incidentally during a routine fetal sonographic examination at 33 weeks of gestation. The cyst remained stable in size prenatally and postnatally without compressive symptoms and signs and the patient has been set under expectant management with serial clinical evaluation and serial imaging of the cyst.

Study of Duration of Fetal Sonographic Examinations [13C

Study of Duration of Fetal Sonographic Examinations [13C

Fetal persistent left superior vena cava in cases with and without chromosomal anomalies

The objectives of this study are to determine and compare the prevalence of persistent left superior vena cava (PLSVC) in chromosomally normal and abnormal fetuses and to evaluate the potential of PLSVC as a screening marker for chromosomal abnormalities. Women undergoing routine fetal sonographic examinations were evaluated once for the presence of PLSVC. PLSVC was diagnosed on the basis of the identification of an additional vessel in the left of the pulmonary artery in a three-vessel trachea view. Associated abnormalities, karyotypes, and outcomes were analyzed. A total of 164 (0.7%, 164/25 171) cases of PLSVC were detected and successfully followed-up. The detection rates were 0.5% (81/17 535) and 1.1% (83/7636) in the low-risk and high-risk cases, respectively. The incidence of PLSVC was lower among the chromosomally or clinically normal (0.4%, 110/24 914) compared with chromosomally abnormal fetuses (7.8%, 20/257, p < 0.001). Additional defects were identified in 90% (18/20) of the PLSVC fetuses with chromosomal anomalies, a rate that was higher than those fetuses with chromosomal normal (61.8%, 68/110). Persistent left superior vena cava is more common among chromosomally abnormal than normal fetuses, and PLSVC fetuses with other defects are more highly associated with chromosomal disorders than isolated PLSVC fetuses. Isolated PLSVC is a benign vascular anomaly and may not affect outcomes.

Sonographic Features of Rare Posterior Fetal Neck Masses of Vascular Origin

The purpose of this series is to describe the grayscale and color Doppler sonographic characteristics as well as the histopathologic features of rare solid posterior neck masses identified on prenatal sonography in pregnant patients. We conducted a retrospective review of detailed fetal sonographic examinations of second- and third-trimester pregnancies referred to the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia for suspected fetal neck masses from June 1998 to December 2011. Eight predominately solid posterior neck masses were identified on 139 studies performed during the study period. Of the 7 cases in which follow-up was available, 6 were confirmed as hemangiomas, and 1 was confirmed as a kaposiform hemangioendothelioma with Kasabach-Merritt syndrome. The most common sonographic features were hypervascularity (7) and calcifications (5). Posterior solid fetal neck masses are rare anomalies. Hemangioma is the most common etiology and should be suggested as the likely diagnosis rather than teratoma, even in the presence of calcifications.

Sonographic Features of Rare Posterior Fetal Neck Masses of Vascular Origin

The purpose of this series is to describe the grayscale and color Doppler sonographic characteristics as well as the histopathologic features of rare solid posterior neck masses identified on prenatal sonography in pregnant patients. We conducted a retrospective review of detailed fetal sonographic examinations of second- and third-trimester pregnancies referred to the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia for suspected fetal neck masses from June 1998 to December 2011. Eight predominately solid posterior neck masses were identified on 139 studies performed during the study period. Of the 7 cases in which follow-up was available, 6 were confirmed as hemangiomas, and 1 was confirmed as a kaposiform hemangioendothelioma with Kasabach-Merritt syndrome. The most common sonographic features were hypervascularity (7) and calcifications (5). Posterior solid fetal neck masses are rare anomalies. Hemangioma is the most common etiology and should be suggested as the likely diagnosis rather than teratoma, even in the presence of calcifications.

Prenatal Diagnosis of a Suprasellar Arachnoid Cyst With 2- and 3-Dimensional Sonography and Fetal Magnetic Resonance Imaging

Arachnoid cysts are intra-arachnoid sacs containing cerebrospinal fluid-like liquid and represent 1 % of all intracranial masses in neonates. 1 Although well reported, the precise etiology and pathogenesis of arachnoid cysts are uncertain. Being developmental in origin, arachnoid cysts can be detected on prenatal screening. Although sonography is used routinely for fetal assessment, it is difficult to account for some of the additional anomalies. We report a rare case of a suprasellar arachnoid cyst detected incidentally during a routine fetal sonographic examination at 24 weeks' gestation, with prenatal 2- and 3-dimensional sonography, fetal and neonatal magnetic resonance imaging (MRI), and postnatal follow-up.

Fetal aberrant right subclavian artery in normal and Down syndrome fetuses

To evaluate the prevalence of fetal aberrant right subclavian artery (ARSA) in a low-risk population and compare it with that among Down syndrome fetuses, in order to estimate its potential as a marker in Down syndrome screening. Women undergoing routine fetal sonographic examination between 13 and 26 weeks of gestation were evaluated once for the presence of ARSA using either a transvaginal multifrequency 5-9-MHz probe or a transabdominal 4-8-MHz probe as appropriate. Early pregnancy outcome was obtained in all cases. Nine hundred and twenty-four fetuses were recruited. An ARSA was detected in 13 fetuses (1.4%) with normal karyotype. During the study period, eight fetuses with Down syndrome referred either with known karyotype or with signs suspicious for Down syndrome were evaluated by the same protocol. Three of eight fetuses (37.5%) were found to have an ARSA. In none of these cases was ARSA an isolated finding. The odds ratio for ARSA in Down syndrome compared with normal fetuses was 42.04 (95% CI, 9.08-194.6). An ARSA was found in 1.4% of the normal population. In the small group of Down syndrome fetuses we observed a trend towards a higher rate of ARSA than in normal fetuses. In none of the Down syndrome fetuses was ARSA an isolated finding. Larger prospective studies are needed to examine the significance of ARSA as an isolated finding and the potential of ARSA as a marker in Down syndrome screening.

OC101: Fetal aberrant right subclavian artery in normal fetuses and in Down syndrome

To evaluate the prevalence of fetal aberrant right subclavian artery (ARSA) in a low-risk population and compare with the rate of its appearance among Down syndrome (DS) fetuses, and to estimate its potential as a marker in DS screening. This was a cross-sectional sonographic study. Women attending routine fetal sonographic examination between 13 and 26 weeks of gestation were evaluated for the presence of an ARSA using either a transvaginal multifrequency 5–9-MHz probe or transabdominal 4–8-MHz probe as appropriate. Early pregnancy outcome was obtained in all cases. Nine hundred and twenty-four fetuses were recruited. ARSA was detected in 13 fetuses (1.41%) with normal karyotype. During the study period, eight fetuses referred either with known karyotype or with signs suspicious of DS were evaluated by the same protocol. Three of eight fetuses (37.5%) were found to have ARSA. In none of these cases was ARSA an isolated finding. The odds ratio for ARSA in DS vs. normal fetuses was 41.9 (95% CI, 8.9–195). ARSA was found in 1.41% of the normal population. In this study we observed a trend toward a higher rate of ARSA among DS fetuses. In none of these was ARSA an isolated finding. Larger prospective studies are needed to test the strength of this marker as an adjunct tool in DS screening and risk assessment.

Sonographic visualization of the middle phalanx of the fetal fifth digit between 13 and 17 weeks of gestation

To assess in utero visualization of the middle phalanx of the fifth digit (MPFD) between 13 and 17 weeks of gestation. This was a prospective cross-sectional study in which women attending for fetal sonographic examination between 13 + 0 and 17 + 6 weeks of gestation were evaluated for the presence of the middle phalanx of the fifth digit (MPFD). A total of 682 fetuses with normal findings on first-trimester anatomical examination were recruited. Using transvaginal multifrequency 4-8 and 5-9 MHz probes, the fifth finger was examined in both axial and lateral views until optimal visualization of the MPFD was achieved. The MPFD was visualized in 14.3% (2/14) of cases at 13 weeks, 70.3% (154/219) at 14 weeks, 82.2% (240/292) at 15 weeks, 97.4% (111/114) at 16 weeks and 100% (43/43) at 17 weeks of gestation. Ultrasound visualization of the MPFD gradually increases during the 13- to 17-week period. This emphasizes the limited role of non-ossification of the MPFD as a sonographic marker of Down syndrome before 17 weeks of gestation.

Color Doppler twinkling artifact in intrauterine fetal demise

To determine whether twinkling artifacts on color and power Doppler sonography could be used as a new sonographic sign of intrauterine fetal demise (IUFD). In this prospective study, 24 consecutive pregnant women with IUFD were included after fetal sonographic examinations. Sonographic examination included gray-scale, color, power, and spectral Doppler imaging. The sonograms were then analyzed for the presence, appearance, and intensity of the twinkling artifacts. Twinkling artifacts on color Doppler were observed in all of the 24 IUFD as a rapidly changing color Doppler signal complex associated persistently with different parts of the fetal body. The artifacts were localized especially in the neck, back, and iliac regions. Artifact intensity correlated with the time elapsed since death. Twinkling artifact was noted in all dead fetuses on color, power, and spectral Doppler examinations. Thus, the observation of these artifacts may be considered as a new sonographic sign of fetal demise, which may reflect the time elapsed since death.

Sacrococcygeal teratoma in a fetus with prenatally diagnosed partial trisomy 10q (10q24.3→qter) and partial monosomy 17p (p13.3→pter)

Clinical features of the distal 10q trisomy syndrome consist of mental retardation, facial dysmorphism and renal and cardiac anomalies. The presence of a sacrococcygeal teratoma (SCT) in a fetus with distal 10q trisomy has not been reported yet. A 33-year-old, G5, P2 woman with a singleton pregnancy was referred to our clinic at 24 weeks of gestation for further evaluation of a fetal sacral exophytic mass. Detailed fetal sonographic examination together with chromosomal analysis by amniocentesis was performed. The scan revealed a large SCT together with a persistent right umbilical vein, cardiomegaly, bilateral mild hydronephrosis and intrauterine growth retardation. The fetal karyotype showed distal 10q trisomy (10q24.3-->qter) distal monosomy 17 (p13-->pter). The fetus died after a preterm delivery at 28 weeks of gestation. Postnatal examination confirmed the prenatal findings and added the typical facial features of this syndrome, which consisted of prominent forehead, small nose with depressed nasal bridge, micrognathia and bow-shaped mouth. This case provides further evidence of a possible association between chromosomal aberrations in SCTs.

Management of a suprasellar arachnoid cyst identified using prenatal sonography

We present a rare case of suprasellar arachnoid cyst discovered incidentally on routine fetal sonographic examination. Serial sonographic and MRI scanning led to a prenatal diagnosis and appropriate endoscopic treatment at 5 months of age. The patient is currently developing normally at 3 years of age. Careful screening of fetal intracranial abnormalities is important in routine prenatal sonographic examination for early intervention, which will prevent irreversible complications such as endocrine disorders and visual impairment.

MRI of the fetal spine.

Magnetic resonance imaging of the fetal spine is a vital complement to fetal sonographic examination. Assessing the wide spectrum of spinal dysraphism, as well as spinal neoplasia, allows for more correct prenatal diagnoses, patient care planning, and patient counselling. Proper appraisal of the value of experimental procedures, such as fetal myelomeningocoele repair, requires a high level of diagnostic accuracy for the selection and follow-up of appropriate candidates.

Persistent Intrahepatic Right Umbilical Vein in the Fetus

In Brief Objective To evaluate outcomes of fetuses with antepartum sonographic diagnoses of persistent intrahepatic right umbilical veins. Methods A detailed fetal sonographic examination was done in 30,240 consecutive pregnancies at 14–26 weeks' gestation. High- and low-risk pregnancies were included and persistent right umbilical veins specifically were recorded. Results Sixty-nine fetuses had persistent intrahepatic right umbilical veins, of which 60 had no additional sonographic abnormalities, four had transient nuchal findings, and four had minor anomalies or anatomic variants. Only one of the 69 fetuses had a major anomaly (diaphragmatic hernia), and died after surgery. The remaining 68 fetuses were normal and healthy after birth. Conclusion Persistent intrahepatic right umbilical vein is a fetal anatomic variant that is not rare and usually associated with a favorable outcome. Persistent right intrahepatic umbilical vein is a normal anatomic variant, usually associated with good outcome.

Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant

Objective: To evaluate outcomes of fetuses with antepartum sonographic diagnoses of persistent intrahepatic right umbilical veins. Methods: A detailed fetal sonographic examination was done in 30,240 consecutive pregnancies at 14–26 weeks’ gestation. High- and low-risk pregnancies were included and persistent right umbilical veins specifically were recorded. Results: Sixty-nine fetuses had persistent intrahepatic right umbilical veins, of which 60 had no additional sonographic abnormalities, four had transient nuchal findings, and four had minor anomalies or anatomic variants. Only one of the 69 fetuses had a major anomaly (diaphragmatic hernia), and died after surgery. The remaining 68 fetuses were normal and healthy after birth. Conclusion: Persistent intrahepatic right umbilical vein is a fetal anatomic variant that is not rare and usually associated with a favorable outcome.

Technical factors influencing sonographic visualization of fetal echogenic intracardiac foci.

A fetal echogenic intracardiac focus (EIF) is most commonly a normal variant in a normal fetus, but owing to reports of an increased risk of aneuploidy with EIFs, the finding causes concern when noted on routine obstetric sonograms. This study was undertaken to determine which factors influence the sonographic visualization of fetal EIFs. In part 1 of the study, records from 1,920 fetal sonographic examinations were reviewed for fetal age, indication for sonography, and abnormal findings. For all cases with EIFs recorded and 645 randomly selected cases with no record of EIFs, sonograms were reviewed for heart position at the time of the 4-chamber view, technologist performing the examination, fetal position, heart visibility, transducer frequency, machine type, amount of amniotic fluid, and presence/absence of an EIF. In part 2 of the study, machine settings were evaluated with respect to visualization of EIFs. In part 1 of the study, only the technologist performing the examination and the fetal position were associated with visualization of EIFs. In part 2 of the study, we found that the standard obstetric mode settings are better for visualization of EIFs than are the fetal echocardiographic mode settings. We conclude that technical factors influence visualization of EIFs.

The atria of the fetal lateral ventricles: a sonographic study of normal atrial size and choroid plexus volume.

Evaluation of the cerebral ventricular system is a routine part of all fetal sonographic examinations. Ventriculomegaly and decreased choroid volume are indicators of poor fetal outcome, so it is important to know the normal variation of these parameters. The present study describes the normal size of the fetal lateral ventricular atrium and the normal amount of choroid plexus within the atrium during the second and third trimesters. Six hundred eight consecutive, healthy, singleton fetuses from 13 to 42 weeks' menstrual age were examined prospectively. The atrium of the lateral ventricle was measured in the axial and coronal planes. For each axial measurement, the width of the choroid plexus was determined. An axial atrial measurement was obtained in 88% of the fetuses, and a coronal atrial measurement was obtained in 84%. The mean measurement and one standard deviation are 6.5 +/- 1.5 mm in the axial plane and 6.6 +/- 1.5 mm in the coronal plane. Ninety-eight percent of all measured atria were at least 60% filled by choroid plexus, and in all cases the atria were at least 50% filled. Complete filling by choroid plexus occurred in 58% of cases. This large prospective study confirms previous observations of mean atrial size. However, four standard deviations above the mean is 12 mm, suggesting currently used cutoffs for normal atrial size are too low. Other parameters, such as choroid plexus filling, may be helpful markers of normalcy in fetuses with atrial measurements between 8 and 12 mm.