Obstetric Sonograms Research Articles

Exploring the Impact of Obstetric Sonographers Dealing With and Supporting Patients Who Receive Negative Outcomes

Because of the complex circumstances in pregnancy, obstetric (OB) sonography requires dissemination of results, often during the examination, and the sonographer can be highly involved in that reporting. This creates a complex set of work responsibilities, in which patient support is of utmost importance, especially when the results are unfavorable. While patient experiences of receiving a negative outcome, during an OB sonogram, have been widely reported, there is a lack of literature on the experience of the sonographers involved in delivering this information. Thus, it is important to identify variables that impact providing ethical care for grieving OB patients. Sonographers in a maternal-fetal medicine clinic work very closely with a group of physicians, and other providers, in delivering unfavorable results, making communication, and understanding of roles of the utmost importance. Conversely, sonographers in a general OB/gynecology practice may not have the support of colleagues when communicating with the grieving patient. These demands may cause feelings of guilt, uncertainty, and stress, contributing to the experience of burnout for the OB sonographer. To prevent these feelings, it is important to consider ways to create a positive work environment and provide resources to protect sonographer mental health. Health care systems must ensure employee access to resources for managing stress, because of caring for grieving patients, and prioritize a healthy work environment, even during challenging times. Future studies are needed that investigate possible training materials, beyond basic hospital training, which targets the skill set needed to properly care for the grieving OB patient.

The Effects of Placental Location on Maternal and Neonatal Outcomes: A Retrospective Cohort Study

Objective: Published research exists that investigates placental location, as well as maternal and fetal outcomes. It is posited that placental location could be an indicator of subsequent maternal and or infant outcomes that could be identified and proactively treated. The aim of this study was to determine whether indeed there is an association between placental location and specific maternal or fetal outcomes. Materials and Methods: A retrospective chart review was conducted on 361 women, who delivered and had obstetric sonograms in a New York academic hospital, between June 2019 and December 2020. The study variables compared to placental location were maternal demographics, substance use during pregnancy, body mass index, blood type, parity, prenatal care, rupture of membranes, mode of delivery, postpartum hemorrhage, systolic/diastolic (S/D) ratio of the umbilical artery, placental location, gestational age at delivery, birth weight, Apgar scores (1 and 5 minutes), and fetal gender. Results: Statistical significance was appreciated in the 5-minute Apgar score category between anterior and posterior placentas ( P = .03). Conclusion: Further prospective research is needed to determine whether different placental locations indeed has an effect on maternal or neonatal outcomes, in which case women may benefit from more intensive pregnancy monitoring.

SDMS CME Credit – Do Practice Policies Limit Distractions and Improve the Quality During an Obstetric Sonogram?

SDMS CME Credit – Do Practice Policies Limit Distractions and Improve the Quality During an Obstetric Sonogram?

Do Practice Policies Limit Distractions and Improve the Quality During an Obstetric Sonogram?

Objective: To assess if distractions alter sonographers’ perceptions of an obstetric sonogram’s (OBS) quality and whether clinic policies mitigate this association. Materials and Methods: Members of the Society of Diagnostic Medical Sonography were surveyed regarding demographics, perceived distractions during OBS, clinic observer and/or recording policies, plus perceptions of OBS quality concerns. Distraction and OBS quality scores were calculated. Chi-squared tests were used for bivariate analysis. Logistic regression identified independent predictors of OBS quality concerns. Results: There were 805 surveys completed. Many respondents (68%) found more than 75% of behaviors distracting, which was associated with increased reports of OBS quality concerns (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI]: 2.55, 5.15), despite respondents’ demographics or clinic policies. More distracting behaviors (79%, P < .01) and quality concerns (40%, P = .04) were noted by sonographers who wanted, but did not have, recording policies at their clinic. Increased quality concerns correlated with disagreement concerning current recording policies (aOR = 2.89, 95% CI: 1.11, 8.00) and desired but absent observer policy (aOR = 2.24, 95% CI: 1.09, 4.59), regardless of respondent demographics or distraction score. Conclusion: Increased distraction scores are associated with more sonographer reports of OBS quality concerns. The lack of desired policies was associated with increased distractions and quality concerns. Further work is needed to understand the relationship between clinic policies, perceived distraction, and OBS quality.

The Sonographic Evaluation of Gestational Age: A Comparative Study Utilizing Different Biometric Measurement Indices and Fetal Kidney Length

Objective: Various indices have been introduced for estimating sonographic gestational age and have demonstrated varied diagnostic accuracy. The aim of this study was to evaluate the correlation of fetal kidney length (FKL) with some other traditional measurement parameters in determining an accurate gestational age. Materials and Methods: In this prospective study, healthy pregnant women, who had completed a scheduled and routine obstetrical sonogram, were included. During the sonogram, the measurement indices, biparietal diameter (BPD), abdominal circumference (AC), crown rump length (CRL), head circumference (HC), femur length (FL), and FKL were analyzed. The obstetrical measurements had been taken every 4 weeks from the 20th week of the pregnancy, until the end of the pregnancy (e.g., 20th, 24th, 28th, 32nd, 36th, 40th weeks). After data collection, the measurement data were analyzed with SPSS software. Results: There were significant ( P < .05) high strength of associations between FKL and the routine measurements of BPD ( r = 0.668), AC ( r = 0.770), CRL ( r = 0.792), HC ( r = 0.791), and FL ( r = 0.803). Conclusion: These results suggest possible significant positive relationships between FKL and BPD, AC, CRL, HC, and FL. It can be assumed that FKL might be a suitable index for determining gestational age especially in the late second and third trimester, when other measurement indices are less accurate.

The role of fetal echocardiogram after detection of extracardiac anomalies in utero (fetal echocardiogram for extracardiac malformations).

We aimed to investigate the utility of comprehensive screening fetal echocardiography (FE) for patients diagnosed with any type of fetal extracardiac malformation (ECM) at a single multidisciplinary fetal center. We retrospectively reviewed all patients presenting to our referral center for FE due to a prenatal diagnosis of ECM (January 2013-December 2018). Among 641 patients with ≥1 ECM referred for FE, 78 (12.2%) had CHD diagnosed at 25.6±0.5 weeks. The frequency of CHD by type of ECM ranged from 35.1% for craniofacial to 9.8% for thoracic. Increasing number of fetal ECMs was strongly associated with CHD: odds ratio 2.01 (95% confidence interval: 1.06-3.69) for two ECMs, 9.57 (2.00-49.05) for three ECMs, and 11.68 (3.84-37.15) for more than three ECMs. Of fetuses with ECM and an abnormal genetic finding, 33.3% had CHD as compared to 10.9% of those without (p<0.0001). Obstetric anatomy sonogram detected 43.6% of CHD. CHD was commonly diagnosed among fetuses with any type of ECM at our center but was not always detected on obstetric sonogram. As the presence of CHD may impact decision-making and perinatal care, patients with a diagnosis of any fetal ECM should be considered for FE.

The natural history of fetal gallstones: a case series and updated literature review

Introduction The incidence of fetal gallstones is estimated at 0.45% and its clinical relevance after birth remains unknown. This study aimed to describe the natural history of fetal gallstones and their clinical sequelae after birth. Methods We queried a database of fetuses referred for second and third trimester sonograms performed for high-risk pregnancies, and identified cases with fetal gallstones (1996–2019). Demographics, prenatal/postnatal imaging findings, and clinical sequelae were collected. A literature review was performed according to PRISMA guidelines. Results We screened approximately 200,000 obstetric sonograms; 34 fetuses were found to have cholelithiasis. The median gestational age at the time of sonogram was 35 weeks (range 22–38). Fifty-six percent were female and 11.8% were twin pregnancies with one affected fetus. Median maternal age was 28 years (range 17–42). Eight fetuses underwent postnatal imaging and 4 had persistent cholelithiasis. There was one case of in utero demise. Two patients had structural anomalies (renal and cardiac) by sonogram. A subset of 17 patients was followed long-term (range 3–20 years), and none developed clinical sequelae from cholelithiasis. Discussion/Conclusions No child developed postnatal clinical sequelae related to cholelithiasis identified in utero. Fetal cholelithiasis can be managed expectantly without follow-up imaging in asymptomatic patients.

The Mechanism of Prune Belly Syndrome Development: A Sonographic Sequential Assessment

Prune belly syndrome is a rare disorder characterized by the absence of anterior abdominal wall muscles, bilateral cryptorchidism, and urinary tract malformations. The aim of this case study was to illustrate the developmental sequelae of prune belly syndrome, acquired through a series of antenatal sonography. A 20-year-old woman visited a diagnostic medical sonography center for an obstetrical sonogram. Her fetus was diagnosed with megacystis at 15 weeks’ gestation. The mother returned for repeated appointment and to observe fetal changes during the development of prune belly syndrome. First, the megacystis, hydroureter, and hydronephrosis were noted followed by hazy ascitic and amniotic fluid. The hemodynamics were altered in the umbilical artery, middle cerebral artery, and ductus venosus. Subsequently, the pressure was neutralized, but it was observed after birth that the newborn had cryptorchidism, a distended abdomen with wrinkled wall, and absent right kidney. In conclusion, prune belly syndrome could be caused by megacystis due to bladder outlet obstruction in otherwise normal karyotype fetuses. Megacystis leads to hydroureter, hydronephrosis, and abdominal distention. The persistent abdominal distention gives rise to the underdevelopment of anterior abdominal wall muscles and cryptorchidism.

Excerpts From the World Medical Literature: Obstetrics.

Summary: This was a prospective cohort study of 52 400 singleton pregnancies having a routine obstetric sonogram at 350 to 366 weeks gestation in one tertiary care centre in the United Kingdom over a 5-year period. The authors aimed to determine the incidence and types of fetal anomalies detected for the first time in the late third trimester. All patients had the routine second trimester sonogram between 180 and 240 weeks gestation, and 90% of the study population also had a first-trimester scan between 110 and 130 weeks gestation. Pregnancies resulting in a live birth or stillbirth were included, yet those with known aneuploidy were excluded. Ultrasound assessments were performed or supervised by sonographers certified by the Fetal Medicine Foundation. The medical specialists became involved on detection of abnormalities. Although the 350- to 370-week scan was principally done for assessments of fetal growth, fluid volume, and Doppler interrogations of the uterine, umbilical, and middle cerebral arteries, sonographers were also requested to assess fetal anatomy as they would at the routine 180- to 240-week anomaly scan.

Perinatal outcome of fetuses with echogenic intracardiac focus

Objective: Echogenic intracardiacs focus (EIF), a microcalcification of the papillary muscles in either or both ventricles of the fetal heart, is one of the more common ultrasonographic soft markers of trisomy 21. This study aimed to determine the relationship of EIF with trisomies in the presence of various ultrasonographic findings. Materials and Methods: A retrospective study of second-trimester obstetric sonograms (18-24 weeks) was conducted at a tertiary care center over a two-year period. The patients were divided into three groups: isolated EIF (group 1), EIF with at least one soft marker (group 2), and EIF with structural anomalies (group 3). All the groups were divided into subgroups on the basis of a screening test (maternal age ≥ 35, positive combined-triple-quadruple tests). The incidence of chromosome anomalies was evaluated. Results: The authors examined 8,300 patients during the study period and found 170 fetuses with isolated EIF (group 1), 26 fetuses with EIF and soft markers (group 2), and 37 fetuses with EIF and structural anomalies (group 3). Thirteen (8%) patients underwent fetal karyotyping in group 1, 10 (38%) in group 2, and 22 (60%) in group 3. The rate of the invasive test was higher in fetuses exhibiting EIF accompanied by at least one of the soft markers. No trisomy was detected in group 1 or 2. Conclusion: The risk of aneuploidy did not increase in either isolated EIF or in cases with other soft markers but only in cases with structural anomalies.

Prevalence of echogenic intracardiac focus and its association with fetal aneuploidy and adverse perinatal outcomes in Turkish pregnancies

Aim: The association between echogenic intracardiac focus (EIF) and fetal aneuploidy is well established, with a recognized ethnic variation. This study aimed to investigate the prevalence of EIF in Turkish pregnancies and examine its association with fetal aneuploidy and adverse pregnancy outcomes.Material and Methods: We conducted a retrospective cohort study of second-trimester obstetric ultrasonography (16–24 weeks) at a university hospital for over 4 years. During the evaluation, all pregnancies with and without EIF were divided into three groups; Group 1: control group (randomly selected patients without EIF, n = 100); Group 2: isolated EIF group, (EIF is the sole finding, n = 45) and Group 3: non-isolated EIF group, (EIF with accompanying other ultrasound findings for fetal aneuploidy and/or presence of congenital anomalies, n = 21). The pregnancy outcomes of patients with isolated and non-isolated EIF and control group were compared.Results: Overall, 2590 obstetric sonograms were examined, with an EIF prevalence of 2.55%. The presence of other ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased risk of fetal aneuploidy, and 2 of 21 (9.5%) pregnancies in the non-isolated EIF group had fetal aneuploidy. In addition, non-isolated EIF was associated with perinatal mortality, preterm delivery, and polyhydramnios when compared to controls and isolated EIF pregnancies. There was no difference in the pregnancy outcomes between control and patients with isolated EIF.Conclusion: EIF is a rare occurrence in Turkish pregnancies and as a sole finding, it is not associated with fetal aneuploidy or other adverse pregnancy outcomes. However, the presence of ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased rate of fetal aneuploidy and adverse pregnancy outcomes.

The Extended Fetal Cardiac Examination: Is It Feasible in a High-Risk Practice?

The aims of this study were to demonstrate the feasibility of obtaining additional cardiac views as proposed on an extended fetal cardiac examination and to see if there was any variation in individual components of that examination stratified by sonographer training, patient body habitus, or equipment. We retrospectively reviewed 200 consecutive detailed second-trimester high-risk fetal obstetric sonograms that included additional extended cardiac views. We analyzed the percentage of the time individual views were obtained, with variation based on (1) a sonographer with greater than 3 years of training compared with a group with 6 to 12 months of training, (2) 2 different ultrasound units, and (3) different body mass indices. Overall, the highest rate of visualization was achieved with the 4-chamber view (98.2%), whereas the 3-vessel tracheal view had the lowest percentage of visualization (40.2%), among the less experienced sonographers. Differences in successful completion of the extended cardiac views were not statistically different between the sonographer with a level of training greater than 3 years as compared with those with 6 to 12 months' training except for the 3-vessel tracheal view (P < 0.001). There is no statistically significant difference in our ultrasound equipment, when considering only inexperienced sonographers. Increasing body mass index had an inverse relationship with obtaining the components of the detailed cardiac examination. Using state-of-the-art ultrasound equipment and with focused additional training of obstetric sonographers, the majority of extended cardiac views can be obtained. There are exceptions.

Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature

Background Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery. Cases Case 1. 26-year-old, Gravid 4, Para 2113, nonpregnant female with a history of a cesarean delivery underwent placement of an IUD one year after an elective pregnancy termination, presenting with abdominal pain requesting removal of the IUD. On speculum, although the IUD strings were visualized, the IUD could not be removed. Sonogram imaging identified an empty endometrial cavity with the IUD in posterior cul-de-sac. The IUD was removed via laparoscopy. Case 2 34-year-old Gravida 5, Para 4004, at 27 weeks and 3 days gestation, female with history of two previous cesarean deliveries underwent a third cesarean after spontaneous rupture of membranes with comorbid chorioamnionitis. Reproductive history was significant for placement of an IUD that had not been removed or imaged during obstetrical sonograms. The clinical evaluation revealed that the IUD had been spontaneously expelled. On the fifth operative day, the patient is febrile with CT demonstrating the IUD penetrating the anterior surface of bladder. On cystoscopy the bladder mucosa was intact. The IUD was removed via laparotomy with repair of the bladder, serosa, and muscular layer. Case 3 26-year-old, Gravid 4, P3013, nonpregnant female with three previous Cesarean deliveries had an IUD in place. However, with the IUD in situ, the patient conceived and had a spontaneous abortion. After the spontaneous abortion, she presented to clinic to have the IUD removed due to pain that was present since placement. Although the IUD strings were visualized, attempts to remove it were unsuccessful. Imaging identified the IUD outside the uterine cavity. Palpation with a blunt probe laparoscopically revealed a hard object within the adhesion band, close to the cardinal ligament. As per radiology evaluation, IUD was embedded 1cm from the external iliac artery on the right side outside the uterus in the adnexal region. A multidisciplinary procedure with gynecologic-oncologist was scheduled for removal due to the high risk of perioperative bleeding. Conclusion Patients in whom uterine perforation and IUD migration are suspected should have appropriate evaluation that includes transvaginal or transabdominal ultrasound or radiographs to confirm the position of the IUD, regardless of whether they are asymptomatic or present with symptoms. It is particularly important in the presence of a scarred uterus that imaging is used to identify the location of a missing IUD. The uterine scar of a cesarean may facilitate migration of the IUD. Cross sectional imaging, such as CT or MRI scan, may be needed to rule out adjacent organ involvement before surgical removal.

A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate

Mid-trimester transvaginal cervical length assessment can identify women who are at risk of preterm birth and afford opportunities for preterm birth prevention. However, the incidence of a short cervix is low, and some physicians have questioned whether a universal screening program among women without a previous preterm birth would be beneficial. The purpose of this study was to examine whether the introduction of a universal transvaginal cervical length screening program is associated with a reduction in the preterm birth rate. This is a cohort study of women with singleton gestations and without any previous preterm births who underwent an obstetric sonogram at 18-24 weeks of gestation and who had their delivery at a single tertiary institution from January 2007 to January 2014. In July 2011, a program was implemented in which all pregnant women who had a sonogram at 18-24 weeks of gestation were to receive a transvaginal cervical length measurement. The preterm birth rates were compared before and after the implementation of the universal cervical length screening program. Multivariable analysis was used to identify whether the universal cervical length screening program was associated independently with the frequency of preterm birth. The Breslow-Day test for homogeneity was used to assess whether any interaction existed in the association based on parity. Of 64,207 eligible women, 46,598 underwent their mid-trimester sonogram before the universal cervical length screening program, and 17,609 underwent a sonogram after implementation of the program. Of the 17,590 women (99.9%) who agreed to cervical length measurement, 157 (0.89%) had a measurement of ≤25 mm. The introduction of the cervical length program was associated with a significant decrease in the frequency of preterm birth at <37 weeks of gestation (6.7% vs 6.0%; adjusted odds ratio, 0.82 [95% confidence interval, 0.76-0.88]), <34 weeks of gestation (1.9% vs 1.7%; adjusted odds ratio, 0.74 [95% confidence interval, 0.64-0.85]), and <32 weeks of gestation (1.1% vs 1.0%; adjusted odds ratio, 0.74 (95% confidence interval, 0.62-0.90]). This reduction in frequency of preterm birth primarily was due to a change in spontaneous (and not medically indicated) preterm births. The effect size for the reduction in preterm birth was similar in nulliparous and multiparous women with previous term births. The introduction of a universal transvaginal cervical length screening program in women without a history of preterm birth is associated with a reduction in the frequency of preterm birth.

Echogenic intracardiac focus on second trimester ultrasound: prevalence and significance in a Middle Eastern population

Objective: The association between echogenic intracardiac focus (EIF) and trisomy 21 is well established, with a recognized ethnic variation. Our study aimed to determine the prevalence of EIF in a Middle Eastern population and to examine its association with trisomy 21 and other adverse pregnancy outcomes. Methods: Retrospective case-control study of second-trimester obstetric sonograms (16–28 weeks) performed at a tertiary care center over a 5-year period. Cases with EIF were retrieved, and a matched control group with no EIF was identified. The incidence of trisomy 21 and other adverse pregnancy outcomes was compared. Results: A total of 9270 obstetric sonograms were examined, with an EIF prevalence of 2.5% (95% CI: 2.2–2.8%). Of patients with available outcome data, EIF was not associated with trisomy 21 (0/163 versus 1/163; p value = 1.00). Additionally, EIF was not associated with trisomy 18, trisomy 13, small for gestational age, preterm birth, fetal demise, cesarean delivery, operative vaginal delivery, or admission to the neonatal intensive care unit. Conclusion: In a contemporary Middle Eastern population, EIF is a rare occurrence. As an isolated finding, it is not associated with aneuploidy or other adverse pregnancy outcomes. EIF appears to be incidental with no impact on clinical practice.

Moral implications of obstetric technologies for pregnancy and motherhood.

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a "good" pregnant woman and to be a "good" (future) mother. Activities in the medical field of reproduction contribute to "kinning", that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: (1) informed consent in prenatal care, (2) obstetric sonogram, and (3) birth plan. Their widespread application is supposed to serve the moral (and legal) goal of effecting patient autonomy (and patient right). A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework.

Bioeffects Reference Tool May Not Improve Sonographers’ Monitoring of Mechanical and Thermal Indices in Obstetric Sonography Examinations

This research examines whether using a reference tool alters the monitoring of the mechanical index (MI) and thermal index (TI) during obstetric (OB) sonograms. A presurvey regarding users’ behavior patterns of monitoring MI/TI indices was emailed to sonographers who were registered in a clinical database affiliated with an accredited sonography program. The presurvey included a reference tool which respondents were asked to print and use when performing OB sonograms. A postsurvey was sent to the same respondents to determine if behavior patterns regarding MI/TI monitoring improved after using the reference tool. There were no significant changes in how often sonographers monitored MI/TI from the pre- to the postsurvey.

Increasing Recognition of Fetal Heart Anatomy Using Online Tutorials and Mastery Learning Compared With Classroom Instructional Methods

Assessment of the fetal heart is a challenging part of any routine obstetrical sonogram. The practice of teaching and learning this skill demands expertise in the visualization and interpretation of normal sonographic appearances of the fetal heart. Recognition of the pathological features associated with commonly seen congenital heart diseases is also very important. In the study reported here, students in an obstetrical sonography course were randomly assigned to two groups. The students in the control group (classroom instruction) on average assessed correctly all five anatomic cardiac features but determined the normal or abnormal status of only 19% of cases, 4.7of 25 ± 4.4 SD. The experimental group (online tutorials) correctly identified 39% of cases, 9.9 of 25 ± 2.7 SD, P &lt; .01. The average score in the experimental group was greater than 84% of the students in the control group, a one sigma effect. These data support the conclusion that students learning to assess the fetal heart for the presence of congenital heart disease using a series of online tutorials and practice exercises compared with students receiving conventional classroom instruction demonstrated an improved ability to correctly identify normal and abnormal fetal heart structures.

PReS13-SPK-1033: Neonatal lupus

Children born from mothers positive for autoantibodies against SSA/Ro and/or anti-SSB/La ribonucleoproteins may develop heart conduction tissue damage resulting in atrioventricular block and/or transient skin rash, liver enzyme abnormalities and anaemia/thrombocytopenia. Additional transient electrocardiographic abnormalities (sinus bradycardia, QT interval prolongation) have been reported. Such clinical and laboratory manifestations are included in the so-called Neonatal Lupus Syndromes, independently whether the mother is suffering from a systemic autoimmune disease or is totally asymptomatic. The prevalence of the congenital heart block is around 2%, of neonatal lupus rash around 20%, while laboratory abnormalities in asymptomatic babies can be detected in up to 30% of cases. The risk of recurrence of complete heart block is almost ten times higher in the following pregnancies. Most of the mothers are asymptomatic at delivery and are identified only by the birth of an affected child. Their longterm outcome is generally more reassuring than previously assumed and arthralgias and xerophtalmia are the commonest symptoms. A standard therapy for heart blocks detected in utero is still matter of investigation, although fluorinated corticosteroids have been reported to be effective on myocarditic signs when present. Serial echocardiograms and obstetric sonograms, performed at least every two weeks starting from the 16 weeks' gestation, are recommended in anti-Ro/SSA positive pregnant women: the goal is to detect early fetal abnormalities, that might precede complete atrioventricular block and that might be a target of preventive therapy. Transplacental passage of maternal anti-SSA/SSB IgG is thought to be pivotal in inducing tissue damage. However, the discordant appearance of the syndrome in twins does suggest a role also for foetal or environmental factors.

Incidental Finding of Urothelial Cell Carcinoma in a Young Patient During an Early Obstetrical Sonogram

Bladder cancer is a rare finding in young adults. This case demonstrates a 17-year-old female with an incidental bladder mass seen during a first-trimester obstetrical sonogram. Sonographic examination revealed a nonmobile, echogenic mass in the inferior portion of the patient’s bladder. The patient subsequently went to surgery at 18 weeks’ gestation where a cystoscopic resection was performed. The tumor was found to be a low-grade papillary urothelial cell carcinoma. The patient delivered at term without further complications. Early diagnosis of this bladder carcinoma led to prompt diagnosis and treatment for the patient. This diagnosis may not have been possible without the bladder being fully distended.