First-trimester Sonography Research Articles

False-Positive Diagnosis of Congenital Heart Defects at First-Trimester Ultrasound: An Italian Multicentric Study.

Objective. Our objective was to assess the proportion of false-positive CHD cases at the first-trimester evaluation of the fetal heart, performed by experienced operators. Methods. This multicenter retrospective study included of pregnant women with suspicion of CHDs during first-trimester screening for aneuploidies. In all cases, the fetal heart assessments were performed by obstetricians with extensive experience in first-trimester scanning, following an extended protocol proposed by SIEOG national guidelines, which included an axial view of the fetal abdomen and chest to assess visceral situs and evaluation of the four-chamber view (4CV) and three-vessel trachea view (3VTV) with color Doppler. In all suspected cases, fetal echocardiography was offered within 16 and/or at 19-22 weeks' gestation. Results. From a population of 4300 fetuses, 46 CHDs were suspected. Twenty-four cases were excluded from this analysis because the parents opted for early termination of the pregnancies due to associated structural and/or genetic anomalies. For the remaining 22, echocardiography was performed by 16 weeks in 14 cases (64%) and after 16 weeks in 8 cases. In 19 cases (86.4%), a fetal cardiologist confirmed the presence of a CHD. In three cases (13%), the cardiac anatomy was found to be normal at the fetal echocardiography and postnatally. Conclusions. This study shows that the proportion of false-positive cases at the first-trimester ultrasound examination of the fetal heart, performed by experienced operators, may carry a higher risk of false-positive diagnosis than expected. Therefore, this issue must be discussed in instances where a CHD is suspected at the first-trimester screening.

Detection Rate of Fetal Anomalies in Early Mid-Trimester Compared to Late Mid-Trimester Detailed Scans: Possible Implications for First-Trimester Sonography.

Objective: A late mid-trimester fetal organ scan (lMTS) is recommended between 18 and 22 weeks of pregnancy. Evidence has been accumulating on the effectiveness of first-trimester anatomy scans. Early mid-trimester fetal scans (eMTSs; 14-17 weeks) may have the advantage of visualization of most organs, hence allowing earlier genetic assessment and decision making. Our aim is to examine the effectiveness of eMTSs in identifying fetal anomalies compared to lMTSs. Methods: A retrospective study was conducted based on data from the multidisciplinary prenatal diagnosis clinic in a tertiary center. During the study period (2011-2021), an out-of-pocket eMTS in a community setting was offered routinely to the general population. Women who had previously undergone an eMTS and were later assessed due to a fetal anomaly in our clinic were included in the study. The cohort was divided into two groups according to whether the anomaly had been detected during the eMTS. We then compared the groups for factors that may be associated with anomaly detection in eMTSs. We used t-tests and chi-square tests, for quantitative and qualitative variables, respectively, to determine variables related to eMTS anomaly detection, and logistic regression for multivariate analysis. Results: Of 1525 women assessed in our multidisciplinary clinic, 340 were included in the study. The anomaly detection rate of the eMTS compared to the lMTS was 59.1% The eMTS detection rates for specific organ systems were as follows: skeletal, 57%; cardiac, 52%; congenital anomalies of the kidneys and urinary tract (CAKUT), 44%; central nervous system, 32.4%; chest, 33%; and abdominal, 28%. In multivariate analysis, abnormal first-trimester screening (aOR 3.2; 95%CI 1.26-8.08) and multiple anomalies (aOR 1.86; 95%CI 1.02-3.37) were found to be associated with eMTS anomaly detection. Conclusions: The eMTS detection rate was nearly 60% and was most accurate in detecting skeletal, cardiac, and CAKUT anomalies. Since the eMTS was community-based, this rate likely reflects a "real-world" scenario. Our findings support consideration of performing an eMTS or first-trimester scan routinely for earlier diagnosis and decision making, as an adjunctive to lMTSs. Future studies will examine the cost-effectiveness of early scans.

Prevalence Of Congenital Abnormalities On Routine Antenatal Ultrasonography During Second And Third Trimester Of Pregnancy: A Study In A District Hospital Of North East India

Background Prevalence of congenital anomalies varies greatly from country to country. It is reported about 2.5% in India. In India, congenital anomalies are responsible for 15% of perinatal mortality and for 10% to 15% of neonatal deaths. The main aim of the study is to evaluate the prevalence of the congenital anomalies and malformation patterns in our hospital population. Material & Method This is a cross-sectional study carried out in the ‘Radiology unit’ of ‘District Hospital, Gomati’, Tripura. The study population includes about 910 antenatal mothers in the second and third trimester, who were referred to ‘Radiology unit’ from the outpatient and inpatient departments of ‘Obstetrics and Gynaecology’ of the same hospital between September 2017 to February 2018 were included in the study. Data of Antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomaly in 2nd & 3rd trimester. Results: Total 910 numbers of 2nd and 3rd trimester prenatal ultrasonography (USG) were done. Out of these 18 numbers of congenital anomalies were detected. The antenatal prevalence of congenital anomalies was 1.97%. The mean maternal age and mean gestational age at diagnosis was 22.9 years and 27.7 weeks respectively. Genitourinary system defect was the commonest (27.77%), of which maximum number had pyelactasis i.e. 3 (16.66%) cases. Conclusion: Ultrasonography is a cost-effective, non-invasive and sensitive tool in detecting the congenital anomalies antenatally in the hands of an experienced radiologist. Besides the first-trimester USG, the second trimester scan is mandatory in detecting anomaly in the growing foetus, as the majority of congenital anomalies are detected between 20 and 22 weeks of pregnancy

A novel software for method comparison: MCS (method comparison software)—assessing agreement between estimated fetal weights calculated by Hadlock I–V formulas and birth weight

IntroductionThe evaluation of the performance of new methods, expected to provide cheaper and faster results than existing (reference) methods in the health field, is based on comparing the results obtained with this new method to those obtained with the existing method. The primary aim of this study is to examine the correlational and absolute agreement between measurement methods in clinical studies using Bland–Altman analysis and methodological (Ordinary Least Squares, Weighted Ordinary Least Squares, Deming, Weighted Deming, Passing–Bablok, Theil-Sen, and Passing–Bablok for Large Data Sets.) methods, and the secondary aim is to compare the accuracy and precision of Hadlock (I–V) formulas used for fetal weight estimation.Materials and methodsThe study was conducted on singleton pregnancies examined in the Prenatal Diagnosis and Treatment Unit of the Department of Obstetrics and Gynecology at Inonu University Faculty of Medicine and who gave birth in the Obstetrics Unit between 01.01.2020 and 01.09.2023, whose gestational ages were confirmed by first-trimester ultrasonography. Estimated fetal weights were calculated using Hadlock (I–V) formulas, and the agreement of these weights with birth weight was evaluated with Bland–Altman method.ResultsThe comparison of estimated fetal weights calculated using Hadlock formulas with birth weight was analyzed using Bland–Altman analysis, ICC, and CCC values along with regression analyses. According to the mean difference values obtained by Bland–Altman analysis, the estimated fetal birth weights obtained by the Hadlock IV formula were most consistent with the actual birth weights.ConclusionsThe estimated fetal weights obtained using the Hadlock IV formula resulted in the closest measurements to the birth weight. This study showcases the efficacy of a new web-based software, Method Comparison Software (MCS), which can be utilized for evaluating the agreement between different methods in clinical measurements.

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

HIGHLIGHTS Conjoined twins have captivated mankind for centuries due to the rarity of this birth type; nonetheless, physicians have constantly encountered difficulties in dealing with conjoined twins. Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy. First-trimester ultrasonography and MRI are complementary modalities in determining the diagnosis and prognosis of conjoined twins in early pregnancy. ABSTRACT Objectives: To discuss the crucial early diagnosis of conjoined twins to determine the type and prognosis. Case Report: A 27-year-old woman was referred to the type A referral hospital with suspicion of congenital abnormalities at 17 weeks of pregnancy. Ultrasound results showed intrauterine monochorionic monoamniotic twins with babies fused on their heads to the urogenital part. The MRI showed a craniopagus, suspected meningomyelocele, and severe bilateral hydronephrosis in the second baby. Due to non-separable cases and a bad prognosis for the fetus, the pregnancy was terminated using misoprostol induction and inserting a balloon catheter. The fetus is born weighing 400 g and 20 cm in length. Conjoined twins obtained the rostral type: a fused head with two faces, a fused thorax until the lower abdomen with one umbilicus, and two pairs of hands and feet. The diagnosis of conjoint twins becomes a problem in early pregnancy, mostly in developing countries. Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy to prevent maternal stress and complications. Conclusion: Conjoined twins should be identified as soon as feasible to establish the best course of management for both mother and fetus. Ultrasonography and MRI are modalities for determining the diagnosis and prognosis of conjoined twins.

Inequalities in access to prenatal care during the COVID-19 pandemic: Analysis of a population-based cohort.

Before the COVID-19 pandemic, access to prenatal care was lower among some socio-demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities. To investigate if the COVID-19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio-economic situation (SES) and are recent immigrants. We used linked administrative datasets from ICES to identify a population-based cohort of 455,245 deliveries in Ontario from January 2018 to December 2021. Our outcomes were first-trimester prenatal visits, first-trimester ultrasound and adequacy of prenatal care. We used joinpoint analysis to examine outcome time trends and identify trend change points. We stratified analyses by age, rural residence, SES and recent immigration, and examined risk differences (RD) with 95% confidence intervals (CI) between groups at the beginning and end of the study period. For all outcomes, we noted disruptions to care beginning in March or April 2020 and returning to previous trends by November 2020. Inequalities were stable across groups, except recent immigrants. In July 2017, 65.0% and 69.8% of recent immigrants and non-immigrants, respectively, received ultrasounds in the first trimester (RD -4.8%, 95% CI -8.0, -1.5). By October 2020, this had increased to 75.4%, with no difference with non-immigrants (RD 0.4%, 95% CI -2.4, 3.2). Adequacy of prenatal care showed more intensive care as of November 2020, reflecting a higher number of visits. We found no evidence that inequalities between socio-economic groups that existed prior to the pandemic worsened after March 2020. The pandemic may be associated with increased access to care for recent immigrants. The introduction of virtual visits may have resulted in a higher number of prenatal care visits.

Changing Trends in the Clinical Presentation and Incidence of Molar Pregnancy in Saudi Arabia: A 30-Year Retrospective Analysis.

Background Molar pregnancy (MP) incidence and clinical presentation vary significantly worldwide. Recent trends show changes in its clinical representation and incidence, particularly with the adoption of early diagnosis using first-trimester ultrasonography, which has reduced the prevalence of classical second-trimester presentations. This study aimed to analyze the changes in clinical presentation and incidence of MP among the Saudi population over the past 30 years. Methods In this retrospective study at King Fahad University Hospital, 121 complete mole (CM) pregnancy cases diagnosed and pathologically confirmed were reviewed. This included 87 cases from 2007 to 2022 (recent group) and 34 cases from 1992 to 2006 (older group). Cases of CM diagnosed before January 1992 and other diagnoses such as PM, invasive mole, or choriocarcinoma were excluded; thus, this study is focused on CM in particular. We compared patient age, gravidity, parity, abortion history, gestational age at diagnosis, hyperemesis gravidarum symptoms, anemia symptoms, and hemoglobin levels. Classical symptoms and signs related to CM were also reviewed. Data were analyzed using Microsoft Excel 2021 (Microsoft Corporation, Redmond, Washington, United States) and presented as mean, frequency, and percentage, with chi-squared tests for categorical variables; p<0.05 was considered statistically significant. Results The incidence of CM declined from 2.1 per 1,000 deliveries to 0.9 per 1,000 deliveries. Vaginal bleeding was the most common presentation in both the older (91.9%) and recent (67.6%) groups. Hyperemesis gravidarum prevalence was similar in both groups. Theca-lutein cysts were more frequent in the older group (27.5%) than the recent group (8.8%). A significant difference was observed in the occurrence of a large-for-date uterus between the older (63.20%) and recent (23.5%) groups. Notably, 14.7% of patients in the recent group were asymptomatic at diagnosis. Anemia was present in 46 cases (52.8%) of the older group but absent in the recent group, and preeclampsia occurred in 10 cases (11.4%) of the older group but not in the recent group. Conclusions Advancements in ultrasound technology, including transvaginal probes with Doppler capabilities, have enabled earlier pregnancy diagnosis, as early as five to six weeks of gestation. Many MP are now diagnosed in the first trimester without the classic clinical symptoms or "snow-storm" ultrasound appearance. The availability of sensitive beta-human chorionic gonadotropin assays has led to the early termination of these pregnancies, marking a significant shift in the management of MP.

A Rare Case of Early-diagnosed Trisomy 13 Syndrome with Typical Semilobar Holoprosencephaly, Cyclopia, and Proboscis: A Case Report

Trisomy 13 syndrome is a lethal chromosomal disorder characterized by severe congenital anomalies. We report a case of trisomy 13 syndrome with semilobar holoprosencephaly, cyclopia, proboscis, omphalocele, and an absent nasal bone, prenatally diagnosed by first-trimester ultrasonography. The diagnosis was confirmed by chromosomal analysis. The pregnancy was eventually terminated at 14 weeks of gestation. The poor prognosis of trisomy 13 syndrome and holoprosencephaly prompts the demand for early prenatal diagnosis. We present this case to introduce some of the typical features of semilobar holoprosencephaly, including an anteriorly fused ventricle with partially fused thalami and absent falx, and to sensitize physicians to similar sonographic findings in the future.

The value of detailed first-trimester ultrasound in the era of noninvasive prenatal testing

In 2020, the American College of Obstetricians and Gynecologists recommended noninvasive prenatal testing be offered to all patients. However, current societal guidelines in the United States do not universally recommend a detailed first-trimester ultrasound. This study aimed to determine the additional findings identified through first-trimester ultrasound that would have otherwise been missed if noninvasive prenatal testing was used alone as a first-trimester screening method. This was a retrospective cohort study involving 2158 pregnant patients and 2216 fetuses that were seen at a single medical center between January 1, 2020, and December 31, 2022. All those included underwent both noninvasive prenatal testing and detailed first-trimester ultrasound between 11.0 and 13.6 weeks of gestation. Noninvasive prenatal testing results were categorized as low risk or high risk, and first-trimester ultrasound results were categorized as normal or abnormal. Abnormal first-trimester ultrasounds were further classified as first-trimester screening markers (increased nuchal translucency, absent nasal bone, tricuspid regurgitation, and ductus venosus reverse a-wave) or structural defects (the cranium, neck, heart, thorax, abdominal wall, stomach, kidneys, bladder, spine, and extremities). Descriptive statistics were used to report our findings. Of 2216 fetuses, 65 (3.0%) had a high-risk noninvasive prenatal testing result, whereas 2151 (97.0%) had a low-risk noninvasive prenatal testing result. Of those with a low-risk noninvasive prenatal testing result, 2035 (94.6%) had a normal first-trimester ultrasound, whereas 116 (5.4%) had at least 1 abnormal finding on first-trimester ultrasound. The most common screening marker detected within the low-risk noninvasive prenatal testing group was absent nasal bone (52/2151 [2.4%]), followed by reversed a-wave of the ductus venosus (30/2151 [1.4%]). The most common structural defect in this group was cardiac abnormality (15/2151 [0.7%]). Overall, 181 fetuses were identified as having "abnormal screening" through either a high-risk noninvasive prenatal testing result (n=65) or through a low-risk noninvasive prenatal testing result but abnormal first-trimester ultrasound (n=116). In summary, the incorporation of first-trimester ultrasound screening identified 116 additional fetuses (5.4%) that required further follow-up and surveillance than noninvasive prenatal testing alone would have identified. Detailed first-trimester ultrasound identified more fetuses with a potential abnormality than noninvasive prenatal testing alone. Therefore, first-trimester ultrasound remains a valuable screening method that should be used in combination with noninvasive prenatal testing.

A Prospective Study on the Reliability of First-Trimester Ultrasound in Identifying the Gestational Sac Implantation Site

A Prospective Study on the Reliability of First-Trimester Ultrasound in Identifying the Gestational Sac Implantation Site

Discrepancy Rate and Associated Factors of Gestational Age Determination by Last Menstrual Period Compared with First-Trimester Ultrasound in Certain Menstrual Period Pregnant Women

Objective: To assess discrepancy rate and associated factors of gestational age (GA) determination by last menstrual period (LMP) compared with first-trimester ultrasound in certain menstrual period pregnant women.0 Materials and Methods: The present study was a cross-sectional study that was conducted at Srinagarind Hospital, Khon Kaen University, Thailand between May 2020 and January 2021. Participants were singleton pregnant women who reported certain LMP dates. GA was estimated using Naegele’s rule and crown-rump length (CRL) measurement. Differences of GA more than five days at GA of 8 or fewer⁶/⁷ weeks and more than seven days at GA of nine⁰/⁷ to twelve⁶/⁷ weeks were considered discrepant. Factors associated with discrepancy were determined by calculating an odds ratio (OR) with a 95% confidence interval (CI). Results: Of the 220 participants, 67 had discrepant GA obtained from LMP and CRL measures, accounting for a rate of 30.5% (95% CI 24.4% to 36.9%). Factors associated with increased risk of discrepant GA consisted of low household income (adjusted OR 2.76; 95% CI 1.43 to 5.31) and long intervals of the menstrual cycle (adjusted OR 3.85; 95% CI 1.85 to 8.02). Conclusion: Approximately one-third of participants in the present study had a discrepancy of LMP and early ultrasound-based GA measures. Factors influencing the risk of discrepant GA between these two methods included household income and interval of menstruation. Keywords: Gestational age; Last menstrual period; First-trimester ultrasound; Discrepancy

Single Umbilical Artery Detected on First-Trimester Ultrasound

Objective: Our research sought to evaluate the utility of a first-trimester ultrasonography diagnostic of a single umbilical artery as a possible indicator of chromosomal abnormalities. Study Design: Retrospective Study Place and Duration: Department of Radiology, Khyber Teaching Hospital Peshawar for the duration from January 2021 to March 2022. Methods: There were 68 pregnant females were of first trimester were presented in this study. Age of the patients was between 18-40 years. After getting informed written consent detailed demographics of enrolled females were recorded. Ultrasound was taken to diagnose single umbilical artery among all cases. SPSS 24.0 was used to analyze all data. Results: Among all, 25 (36.8%) females were aged 18-25 years, 36 (52.9%) cases had age 26-35years and 17 (25%) females had age &gt;35 years. 37 (54.4%) patients had BMI &lt;25kg/m2 and 31 (45.6%) had BMI &gt;25kg/m2. 30 (44.1%) cases were primigravida and 38 (55.9%) cases were multigravida. 40 (58.8%) cases were from rural areas and 33 (48.5%) cases were literate. Overall frequency of single umbilical artery (SUA) was 3 (4.4%) in which 1 (1.5%) in single pregnancy and 2 (2.9%) in twin pregnancy. The first trimester finding had 85% sensitivity, a 97% specificity, a 0.4% false positive rate, and a 14.9% false negative rate. Frequency of malformations was 13 (19.1%). Most cases of severe foetal deformity were detected using ultrasonography in the 16th week. Conclusion: Based on the results of this study, we can say that SUA is a valuable marker for foetal malformation pathology in the first trimester, allowing for the early detection of many instances of malformations before 20 weeks of gestation. Keywords: Ultrasonography, Pregnant Females, First Trimester, Single Umbilical Artery

First trimester ultrasound in the age of cell-free DNA screening: What are we missing?

To evaluate the utility of first trimester (FT) ultrasound (US) between 10 and 14weeks gestation in identifying fetal findings that would impact clinical management. We performed a retrospective review of FT US associated with an abnormal ICD-10 code from August 2016 to December 2018. Results of FT US, genetic testing, and management decisions were abstracted from the electronic health record. A total of 20,594 FT US were performed within our study period, representing 6064 unique patients. Of these, 278 ultrasounds were noted to have fetal findings (278/6064, 4.6%). The most frequent fetal findings were fetal demises (98/278, 35.3%), followed by increased NT/cystic hygroma (67/278, 24.1%), and multiple anomalies (35/278, 12.6%). There was a significant difference between the frequency of fetal findings between patients considered advanced maternal age (AMA) and those who were not (p=0.017). However, there was no significant difference in the frequency of specific anomalies between these two groups (p=0.103). FT US provides clinical information outside the scope of cfDNA screening in both AMA and non-AMA populations regarding viability and fetal anatomy. Earlier detection of these findings is crucial to allow for the opportunity of informed discussion of testing strategy and decision making.

Reappraising the Value of Fetal First-Trimester Ultrasonography

Abstract In the last few years, the introduction of cell-free DNA has rapidly altered prenatal screening regimens and is increasingly offered as the second- or, at times, even the first-tier screening test. Should an early anomaly scan also be part of an up-to-date screening policy? This paper reappraises the value of fetal first-trimester ultrasonography. The primary aims of the first-trimester scan are to establish gestational age based on the measurement of fetal crown-rump length, to detect multiple pregnancy and chorionicity, and to measure fetal nuchal translucency thickness as part of a combined screening test for chromosomal abnormalities. With recent advancements in ultrasound technology, there is compelling evidence that a majority of fetuses with major structural abnormalities and almost half of them without chromosomal abnormalities can be detected in the first trimester. We focused on the first-trimester screening of fetal major defects, especially including fetal congenital heart disease and cleft lip and palate by ultrasound markers and views. Moreover, it is critical to highlight that after a detailed anomaly scan in the first trimester without major structural anomalies and positive genetic tests, the residual chance of favorable outcome in fetuses with isolated increased nuchal translucency is relatively high. The discussion on the role of cell-free DNA in prenatal screening is still ongoing. Even in the event of it becoming a first-line screening test for aneuploidies, the importance of a first-trimester fetal scan, including assessment of markers for other anomalies, remains undisputed.

When a vesicular placenta meets a live fetus: case report of twin pregnancy with a partial hydatidiform mole

BackgroundHydatidiform moles exhibit a distinctive gross appearance of multiple vesicles in the placenta. The advances in cytogenetic technologies have helped uncover novel entities of hydatidiform moles and enabled elaborate diagnoses. However, management of a vesicular placenta with a coexistent live fetus poses a bigger challenge beyond hydatidiform moles.Case presentationA 33-year-old woman was referred to our department for suspected hydatidiform mole coexistent with a live fetus at 24 weeks’ gestation. The patient had conceived through double embryo transplantation, and first-trimester ultrasonography displayed a single sac. Mid-trimester imaging findings of normal placenta parenchyma admixed with multiple vesicles and a single amniotic cavity with a fetus led to suspicion of a singleton partial molar pregnancy. After confirmation of a normal diploid by amniocentesis and close surveillance, the patient delivered a healthy neonate. Preliminary microscopic examination of the placenta failed to clarify the diagnosis until fluorescence in situ hybridization showed a majority of XXY sex chromosomes. The patient developed suspected choriocarcinoma and achieved remission for 5 months after chemotherapy, but relapsed with suspected intermediate trophoblastic tumor.ConclusionWe report a rare case of twin pregnancy comprising a partial mole and a normal fetus that resembled a singleton partial molar pregnancy. Individualized care is important in conditions where a vesicular placenta coexists with a fetus. We strongly recommend ancillary examinations in addition to traditional morphologic assessment in such cases.

Detection rate of fetal CNS anomalies by first and second trimester ultrasound screening

Objectives: The aim of this study was to detect CNS abnormalities in the first and second trimester by ultrasound. Methods: This cross-sectional study was performed on pregnant women who referred to the radiology department of Imam Reza and Valiasr hospitals in Tehran-Iran during 2019-2020. After obtaining informed consent, pregnant women were screened in the first trimester at week 13-13 and then in the second trimester at week 18-20 by a 5-8 MHz Ultrasound Transducer. Each ultrasound included examination of the fetal brain and vertebrae at the axial coronal and sagittal planes in the most important anatomical areas, including the trans-thalamic (TT) or the trans-ventricular (TV) plane, transverse cerebellar, and vertebral canal plan. Ultrasound of the first and second trimesters of all mothers was performed. Information of all pregnant mothers was collected and recorded. Data analysis was performed using SPSS software version 25. Results: In this study, 2234 pregnant women were included in the study. The total rate of detected anomalies was found to be 1.3%. The rate of abnormalities detected in the first trimester was far less than in the second trimester. The prevalence of CNS anomalies in the population under 30 years of age was also found 0.9%, while it was 1.6% in the population over 30 years of age. Conclusion: Second-trimester ultrasound is the method of choice in diagnosing central nervous system abnormalities. However, first-trimester ultrasound is the diagnostic method for structural abnormalities of the skull.

Early Total Versus Gradually Advanced Enteral Nutrition in Stable Very-Low-Birth-Weight Preterm Neonates: A Randomized, Controlled Trial.

To assess whether early total enteral nutrition (80mL/kg/d) started on day 1 of life in hemodynamically stable preterm very-low-birth-weight (VLBW) neonates with the rapid advancement of feeds (20mL/kg/d) help in the earlier achievement of full feeds (180mL/kg/d). Early total enteral nutrition (intervention) group feeding was started with 80mL/kg/d on the first day in all hemodynamically stable neonates admitted with birth weight of 1000-1499grams, born at 29-33 wk of gestation as determined by first-trimester ultrasonography (USG) or expanded New Ballard Score (NBS) and was advanced by 20mL/kg/d until maximum feeds of 180mL/kg/d were achieved; while in control group feeding was started with 30mL/kg/d on the first day and was advanced by 20mL/kg/d until maximum feeds were achieved. Primary outcome measure was time taken to achieve full feeds; secondary outcomes were duration of hospital stay, necrotizing enterocolitis (NEC), time to regain birth weight, duration of antibiotics, and death. Sixty VLBW neonates (1000-1499g) with comparable baseline demographics were randomized within 24h of admission to two groups. Early total enteral nutrition intervention group (group I, n= 31) achieved the target of full enteral nutrition at median 6 d; IQR: 0 to 7.8 d, a significantly shorter time compared to the controls (n= 29) (median 10 d; IQR: 9 to 11.0 d; p= < 0.05). Early total enteral nutrition started from the first day of life results in significantly less time to achieve full feeds in hemodynamically stable preterm and VLBW infants.

Lacunar-like changes of the chorion: can it be a first-trimester ultrasound sign in predicting worse clinical outcome in cesarean scar pregnancy termination?

Objective To observe the lacunar-like changes in cesarean scar pregnancy (CSP) ultrasonography in first trimester and to explore its relationship with clinical outcome in early pregnancy termination. Methods This is a retrospective case-control study. Patients who were diagnosed as CSP and chose to terminate pregnancy from January 2017 to April 2020 were enrolled. According to occurrence of lacunar-like change in chorion membrane, patients were divided into case and control group. The clinical manifestation, laboratory test, ultrasound data, and outcome were compared. Results Fifty-five CSP patients were enrolled with 20 (36.4%) in case group and 35 (63.6%) in control group. As for ultrasound features, the maximum outer diameter of gestational mass (5.6 ± 2.5 cm vs. 3.9 ± 1.5 cm), the maximum thickness of the chorion membrane (median number 1.1 cm vs. 0.7 cm), the longitudinal diameter of the implanting part of gestational mass in uterine lower segment (3.3 ± 1.8 cm vs. 1.2 ± 0.5 cm), uterine lower segment protrusion incidence (12, 60% vs. 2, 5.7%), and the crown-rump length of fetus (median number 1.7 cm vs. 0.7 cm) were bigger or higher in case group than that of the control group; the minimum thickness of the uterine lower segment myometrium (median number 0.08 cm vs. 0.20 cm) was significantly thinner in case group. CDFI grading of case group was different from control group with more cases in higher grades. As for clinical outcome, the patients of case group showed more frequency of CSP lesion resection under open surgery or laparoscopy (7, 35% vs. 1, 2.86%) rather than suction curettage, more blood loss in surgery (median number 35 ml vs. 20 ml) and more hospitalization days (median number 7.5 d vs. 3.5 d) than control group. Conclusions Lacunar-like change of chorion can be detected in early gestation and may act as a predictor of complicated and worse clinical outcome.

Early detection of Fetal Acrania on first-trimester sonography: a case report

Introduction. Fetal Acrania is a rare fetal malformation characterized by the complete or partial absence of a skull covering the fetal brain. In the absence of a hard covering of the soft brain tissue, Acrania is known as a universally lethal malformation. Here we present a Fetal Acrania case detected by sonographic examination at our Center.&#x0D; Case Description. A 36 years old female was referred to the obstetric department to undergo an in-depth sonographic evaluation as a previous examination reveals a potential congenital fetal anomaly. Our sonographic evaluation revealed a singleton, live fetus, 12 weeks gestational age in cephalic presentation and longitudinal lie. One obvious malformation was a well-formed fetal brain without the surrounding cranium (Acrania). The absence of cranium was the main and only malformation. The absence of cranium was evident as the fetal brain was easily compressed on probe pressure, and the brain appeared like floating in the amniotic fluid over the base of the skull. Therapeutic abortion was carried out. The termination was conducted by administering four tablets of 200 mcg misoprostol sublingually and repeated 24 hours later. No adverse reaction or complication on termination. The aborted fetal examination confirmed the lack of fetal cranium.&#x0D; Conclusion. Although seemingly obvious, the first-trimester diagnosis of fetal Acrania must be made with caution as the fetal cranium is not fully calcified before 10- 11 weeks. As Acrania is a universally lethal malformation, therapeutic abortion is indicated.

The Potential of Prenatal Diagnosis in the Early Detection of Congenital Malformations

We present a unique association of fetal malformations very early diagnosed by ultrasoundexamination, at 14 weeks of gestation. A 28-year-old pregnant female, was addressed in a privatemedical center from Bucharest, Romania, for a routine ultrasound screening. A detailed ultrasoundevaluation of the fetus showed numerous and significant cephalic and heart malformations. Theultrasound examination of the fetal head suggest the diagnosis of fetal lobar hydrocephalus, and theultrasound examination of the fetal heart suggest the transposition of the great vessels. The parentswere informed about the severity of the fetal malformations and decided to terminate the pregnancydue to medical reasons. Anatomopathological examination confirmed the prenatal diagnosis. Firsttrimester ultrasonography was crucial in the early prenatal diagnosis and management of themalformed fetus with a unique association of fetal malformations.