Routine Obstetric Scan Research Articles

Gaze-probe joint guidance with multi-task learning in obstetric ultrasound scanning

In this work, we exploit multi-task learning to jointly predict the two decision-making processes of gaze movement and probe manipulation that an experienced sonographer would perform in routine obstetric scanning. A multimodal guidance framework, Multimodal-GuideNet, is proposed to detect the causal relationship between a real-world ultrasound video signal, synchronized gaze, and probe motion. The association between the multi-modality inputs is learned and shared through a modality-aware spatial graph that leverages useful cross-modal dependencies. By estimating the probability distribution of probe and gaze movements in real scans, the predicted guidance signals also allow inter- and intra-sonographer variations and avoid a fixed scanning path. We validate the new multi-modality approach on three types of obstetric scanning examinations, and the result consistently outperforms single-task learning under various guidance policies. To simulate sonographer’s attention on multi-structure images, we also explore multi-step estimation in gaze guidance, and its visual results show that the prediction allows multiple gaze centers that are substantially aligned with underlying anatomical structures.

Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests.

To determine the distribution of major fetal congenital heart diseases (CHDs) diagnosed antenatally during routine second-trimester obstetric anatomical scans in an unselected population at a single tertiary centre and to characterise and stratify risk factors, genetic diagnosis and long-term health at 4 years old. A single-centre cohort study of all major fetal CHDs detected on routine obstetric fetal anatomical ultrasound scans between January 2014 and December 2017 was performed in an unselected population. Demographic details, fetal echocardiogram reports, genetic test results, delivery outcomes and postnatal progress were stratified by CHD subtype. Of 20,031 screened pregnancies, 109 pregnancies (0.53%) had major fetal CHDs. The most common subtypes were coarctation of aorta (17.4%), transposition of great arteries (16.5%), and tetralogy of Fallot and univentricular hearts (13.8% each). Of the 60.5% that underwent confirmatory genetic testing-mostly conventional karyotyping and testing for 22q11 microdeletion-about a quarter had abnormalities, of which 22q microdeletion was the most common. We had complete obstetric data in 85 pregnancies (78%), of which 76.5% progressed to live birth. Among these, 92.1% of postnatal echocardiograms concurred with antenatal ones. At 4 years old, 43.2% of offspring had no medical or developmental issues, 20.0% had mild medical or developmental issues, 21.5% had major medical or developmental issues, and 12.3% had deceased. Fetal echocardiograms accurately diagnose CHDs. Future studies should evaluate the roles of chromosomal microarray and next-generation sequencing in diagnosing CHD.

Point of care obstetric ultrasound knowledge retention among mid-wives following a training program: a prospective cohort pilot study

BackgroundObstetric ultrasound has become a routine part of antenatal care in many parts of the world including low income settings. However, there is a shortage of radiologists and sonographers to perform routine obstetric scans in many areas especially in the rural settings of low income countries, despite having equipment available to do this. As a result, Point of care ultrasound (POCUS) has been suggested to bridge this gap by training other health workers such as midwives to perform basic obstetric ultrasound as part of their clinical care.MethodsIt was a prospective cohort pilot study in which trained midwives in point of care obstetric ultrasound were followed up at 6 months post training to assess their knowledge retention. Eleven trained midwives were purposively selected and followed up for knowledge retention. These were trained for 6 weeks and were given a knowledge assessment immediately after training, then given an assessment at 6 months following training. Data was analyzed using SPSS. Wilcoxon signed rank test was used to compare assessments and perceived knowledge as well as Spearman correlation to test the relationship between the number of scans performed and exam assessments, knowledge and exam assessments, and number of scans and knowledge.ResultsThere were eleven midwives, all female with an average age of 42.3 years. The mean exam score (out of 50) was 44.2 at the end of the training and 42.9 at 6-months follow up. The midwives demonstrated higher perceived knowledge at the end of the training when compared to the 6-months follow up. However, this perceived higher knowledge was not statistically significant when correlated with the exam scores either at the end of the training or at the follow up of 6 months.ConclusionThis pilot study has demonstrated that training midwives in point of care obstetric ultrasound can result into acceptable levels of knowledge retention that assist the midwives to apply this knowledge when making routine clinical decisions in relation to pregnant women.

The Placenta: Anatomy, Pathophysiology, Pathological and Ultrasonograpic Findings

Introduction: The placenta is an organ that connects the developing fetus to the mother to serve the major purpose of respiration, excretion and nutrition for the fetus. It is very important for the proper development of the embryo, cushions it from mechanical shocks a major role in assisting the physiological changes that occur during pregnancy. A thorough examination of the placenta plays an important role in providing significant clinical information that may affect the welfare of the fetus and the mother but sadly, it is less evaluated during routine obstetric ultrasound scan. Objective: This study discussed in simplified details, the developmental anatomy of the placenta, related ultrasonography of the appearance of the typical placenta which provides necessary clinical information and help. predict adverse fetal outcomes. Also discussed were some pathological findings that can be seen in routine ultrasound scan with the hematological complications of placenta previa as a focus. Methodology: The research was designed from search engines with reference to valid studies from academic sources including ResearchGate, PubMed and Google Scholar. We also evaluated various related titles, abstracts and full reports for eligibility. Conclusion: The placenta is a very important organ in the development of the fetus but easily overlooked during routine ultrasound and a proper check of the health can avert morbidity and mortality of the fetus.

Intrauterine Spontaneous Subdural Hematoma with Hydrocephalus

Abstract Subdural hematoma in newborn baby is associated with history of maternal trauma, complicated vaginal delivery, instrumental delivery, foetal / maternal thrombocytopenia, coagulopathy, hepatic disease, infection or using drugs during the pregnancy; but in the absence of the above, intrauterine subdural hematoma is a rare event. We present a newborn delivered to a healthy mother at 38 weeks by elective caesarean section after he had been diagnosed with macrocephaly by routine obstetric growth scan ultrasound at 35 weeks of gestational age. The baby’s APGAR score was 4 at 1 minute, he was pale, his fontanel was tense and his Occipitofrontal circumference (OFC) was 46 cm, therefore, he was intubated immediately and transferred to Neonatal Intensive Care Unit (NICU). Brain Computed tomography (CT –scan) revealed huge right sided subacute subdural hematoma that was almost occupying the entire right hemicranial space and severely compressing the underlying brain tissue. In addition, there was marked dilatation of the left lateral ventricle with blood clots at the occipital horn. Subdural hematoma was evacuated by two burr holes surgery, followed by repeated subdural tap. Intraventricular haemorrhage treated by repeated ventricular tap until Cerebrospinal Fluid (CSF) became clear, then ventriculoperitoneal shunt surgery was done for him. Keywords: Subdural hematoma, Newborn, Hydrocephalus, Burr hole, Shunt surgery.

Incidental finding of a rare anomaly: Bilateral maternal pelvic kidneys

Pelvic kidney occurs when kidney fails to migrate above the pelvic brim during embryologic development. Bilateral pelvic kidneys are rare. We present a 31-year-old multigravida [G4 P3+0] female, who presented for routine early obstetric scan which revealed non-fused kidneys located posterio-lateral to the fundus of the gravid uterus and anterior to the sacrum. Pelvic kidneys are largely asymptomatic; and this was the case in our patient who had three previous uneventful pregnancies and vaginal deliveries without diagnosis of bilateral pelvic kidneys.

Multimodal-GuideNet: Gaze-Probe Bidirectional Guidance in Obstetric Ultrasound Scanning.

Eye trackers can provide visual guidance to sonographers during ultrasound (US) scanning. Such guidance is potentially valuable for less experienced operators to improve their scanning skills on how to manipulate the probe to achieve the desired plane. In this paper, a multimodal guidance approach (Multimodal-GuideNet) is proposed to capture the stepwise dependency between a real-world US video signal, synchronized gaze, and probe motion within a unified framework. To understand the causal relationship between gaze movement and probe motion, our model exploits multitask learning to jointly learn two related tasks: predicting gaze movements and probe signals that an experienced sonographer would perform in routine obstetric scanning. The two tasks are associated by a modality-aware spatial graph to detect the co-occurrence among the multi-modality inputs and share useful cross-modal information. Instead of a deterministic scanning path, Multimodal-GuideNet allows for scanning diversity by estimating the probability distribution of real scans. Experiments performed with three typical obstetric scanning examinations show that the new approach outperforms single-task learning for both probe motion guidance and gaze movement prediction. Multimodal-GuideNet also provides a visual guidance signal with an error rate of less than 10 pixels for a 224 × 288 US image.

Transforming obstetric ultrasound into data science using eye tracking, voice recording, transducer motion and ultrasound video

Ultrasound is the primary modality for obstetric imaging and is highly sonographer dependent. Long training period, insufficient recruitment and poor retention of sonographers are among the global challenges in the expansion of ultrasound use. For the past several decades, technical advancements in clinical obstetric ultrasound scanning have largely concerned improving image quality and processing speed. By contrast, sonographers have been acquiring ultrasound images in a similar fashion for several decades. The PULSE (Perception Ultrasound by Learning Sonographer Experience) project is an interdisciplinary multi-modal imaging study aiming to offer clinical sonography insights and transform the process of obstetric ultrasound acquisition and image analysis by applying deep learning to large-scale multi-modal clinical data. A key novelty of the study is that we record full-length ultrasound video with concurrent tracking of the sonographer’s eyes, voice and the transducer while performing routine obstetric scans on pregnant women. We provide a detailed description of the novel acquisition system and illustrate how our data can be used to describe clinical ultrasound. Being able to measure different sonographer actions or model tasks will lead to a better understanding of several topics including how to effectively train new sonographers, monitor the learning progress, and enhance the scanning workflow of experts.

A study of biochemical parameters in pregnant women in III trimester with non-alcoholic fatty liver disease (NAFLD)

Introduction and Aim: Non-alcoholic fatty liver disease (NAFLD) is one of the common causes of liver cirrhosis among general population.Studieshave identified NAFLD and evaluated lipid profile in pregnant women. Some have explored association that existed between lipid levels and adverse pregnancy outcome in western countries. Our aim was to find the prevalence of non-alcoholic fatty liver disease (NAFLD) in pregnant women among rural population in their III trimester and to assess dyslipidemia in these women.
 
 Materials and Methods: This is a prospective study conducted on 101 rural pregnant women coming for antenatal visits in their third trimester to Dept.,of Obstetrics and Gynaecology,PESIMSR, Kuppam.Liver scan was done during the regular obstetric scan to identify NAFLD. All pregnant women underwent lipid profile testing (Triglyceride,Total Cholesterol, HDL,LDL,VLDL).
 
 Results: There was a 1% prevalence of NAFLD among 101 rural expectant mothers.Lipid profile significantly (p<0.05)increased with increased BMI, parity and highly educated and fairly good socioeconomic background. Women with higher body mass index and triglyceride levels delivered babies with large birth weight(p<0.05).
 
 Conclusion: There are metabolic derangements in pregnant women leading to dyslipidemia even among those who did not have NAFLD. High parity women and those with high atherogenicity are at cardiovascular risk diseases in future. We suggest further studies to establish biological reference ranges for lipid profile during pregnancy. There is a need for, pregnant women to be assessed for dyslipidemia and screened for NAFLD by scanning liver along with routine obstetric scan in tertiary care centre.

Cómo reestructurar una Sección de Medicina Fetal en tiempos de pandemia COVID-19. Medidas de seguridad y limpieza de los equipos ecográficos

During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients’ lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.

ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in context of COVID‐19

ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in context of COVID‐19

Safety Indices of Ultrasound: Adherence to Recommendations and Awareness During Routine Obstetric Ultrasound Scanning.

To analyze bioeffect safety indices and assess how often operators look at these indices during routine obstetric ultrasound. Automated analysis of prospectively collected data including video recordings of full-length ultrasound scans coupled with operator eye tracking was performed. Using optical recognition, we extracted the Mechanical Index (MI), Thermal Index in soft tissue (TIs), and Thermal Index in bone (TIb) values and ultrasound mode. This allowed us to report the bioeffect safety indices during routine obstetric scans and assess adherence to professional organization recommendations. Eye-tracking analysis allowed us to assess how often operators look at the displayed bioeffect safety indices. A total of 637 ultrasound scans performed by 17 operators were included, of which 178, 216, and 243 scans were first, second, and third-trimester scans, respectively. During live scanning, the mean and range were 0.14 (0.1 to 3.0) for TIb, 0.2 (0.1 to 1.2) for TIs, and 0.9 (0.1 to 1.3) for MI. The mean and standard deviation of TIb were 0.15 ± 0.03, 0.23 ± 0.09, 0.32 ± 0.24 in the first, second, and third trimester, respectively. For B-mode, the highest TIb was 0.8 in all trimesters. The highest TIb was recorded for pulsed-wave Doppler mode in all trimesters. The recommended exposure times were maintained in all scans. Analysis of eye tracking suggested that operators looked at bioeffect safety indices in only 27 (4.2 %) of the scans. In this study, recommended bioeffect indices were adhered to in all routine scans. However, eye tracking showed that operators rarely assessed safety indices during scanning.

OC10.02: Bioeffects safety indices of ultrasound: quantifying adherence to recommendations on routine obstetric scan

OC10.02: Bioeffects safety indices of ultrasound: quantifying adherence to recommendations on routine obstetric scan

Structured evaluation and reporting in imaging of placenta and umbilical cord.

The human placenta plays a pivotal role in development and growth of the fetus. Disorder of this multifunctional organ is central to various fetal disorders. Doppler sonography and MRI provide excellent diagnostic evaluation of the placental morphology and umbilical cord. Decades of experience in obstetric imaging have highlighted the need of careful prenatal assessment of placenta. However, in most of the routine obstetric scans, the evaluation and reporting of the placental examination is limited to the location and grade of the placenta. The purpose of this article is to review the existing literature and facilitate step-by-step evaluation of the placenta and umbilical cord by the radiologists.

Fetal Pericardial Effusion: Roles of Prenatal Cardiac Intervention?

Isolated fetal pericardial effusions are frequently detected on routine obstetric scans. The exact incidence and significance of this finding is not clearly understood. The perinatal outcome in such cases depends on the presence or otherwise of associated malformations and chromosomal aberrations. Management of a fetus with pericardial effusion involves a multidisciplinary review of the problem to consider the competing fetal and maternal implications. Close monitoring of the fetal biophysical profile along with serial echocardiographic assessments and pericardiocentesis may allow the delivery to be delayed until adequate lung maturity is achieved. Current evidence indicates good outcome in cases of isolated pericardial effusion. Large prospective studies are needed to resolve the issue of association with chromosomal aberration that has significant impact on antenatal management and counseling policies in such cases.

Reduced fetal brain fissures depth in fetuses with congenital heart diseases.

To screen and detect cortex gyration in fetuses with congenital heart disease (CHD) using Ultrasonography (US) during routine obstetric scans. The depth of the Sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine (CF) fissure were prospectively serially measured and compared in 45 fetuses with CHD and 45 normal fetuses. Cardiac hemodynamic parameters, including aortic valve diameter (AV), pulmonary valve diameter (PV), velocity time integral of the aortic valve (VTIav), and velocity time integral of the pulmonary valve (VTIpv), were recorded. Correlations between the fissure depths and the prenatal cardiac hemodynamic parameters and postnatal neurodevelopmental scores were assessed. SF, POF, and CF were decreased in CHD fetuses compared with the controls in late of pregnancy (P < 0.01). The diagnostic category was independently associated with smaller fissure depths in fetuses with CHD (adjusted R2 = 0.472 for SF, 0.465 for POF, and 0.425 for CF). Correlations were observed between small fissure depths and decreased left heart hemodynamic parameters (AV and VTIav) in fetuses with CHD. The SF depth was positively correlated with the neurodevelopmental scores (P < 0.01). US can be used to screen for abnormal fetal brain cortex development during routine obstetric scans and to evaluate the maturation progress during close follow-up. © 2016 John Wiley & Sons, Ltd.

Impact of maternal knowledge of recommended weight gain in pregnancy on gestational weight gain

Obesity is prevalent among reproductive-aged women and is associated with increased obstetric complications. Weight gain recommendations exist; however, knowledge of these recommendations is low, and few women gain appropriate weight during their pregnancies. Excessive gestational weight gain is common and is associated with adverse outcomes. Little is known about the relationship between knowledge of gestational weight gain recommendations and actual weight gain. Our objectives were to assess knowledge of weightgain recommendations in pregnancy and to determine its association with actual weight gain among women who seek care at an urban, regional perinatal center. We hypothesize that low levels of knowledge will predict inappropriate weight gain in this population. This is a cross-sectional study with linked chartreview of 338 women who sought routine obstetric ultrasound scans at an urban, regional perinatal center that serves a largelylow-income population of predominately black women. Descriptive statistics, chi-square test, and analysis of variance were performed. This population has low rates of accurate knowledge of weight gain recommendations in pregnancy (27%) and low rates of appropriate gestational weight gain (30%). Inappropriate gestational weight gain was highest among women who were obese before pregnancy. Accurate knowledge of gestational weight gain recommendations was associated with appropriate weight gain in pregnancy (P=.02), as was prepregnancy weight category (P= .004) and correct identification of prepregnancy weight category (P= .005). These findings support the need for improvements ineducational efforts about weight gain in pregnancy for high-risk, low-income women in an urban setting, which may improve compliance with the recommendations.

Foetal Ultrasound– A Study of Spina Bifida and Associated Anomalies in Rural Pregnant Women

Objective: To study the incidence and various types of associated anomalies and complications on obstetric ultrasound, in rural pregnant women. To reduce the maternal morbidity and mortality by early detection of these congenital neuroectodermal anomalies. To assist the obstetrician in taking decisions regarding the termination or continuation of the pregnancy in relation to the type of malformation and its prognosis. A prospective and retrospective study of spina bifida and its associated anomalies was done on 23,000 rural pregnant women coming to the Santhiram Medical College, Radiology Department for a routine obstetric scan. A total of 19 cases spina bifida were detected of which 2 cases were pure spina bifida without any complication, 14 cases had hydrocephalus and meningocele or myelomeningocele and 2 cases had meningocele without hydrocephalus. One case had anencephaly with an incidence of 1 per 1,111 cases. History of similar anomaly and intake of iron and folic acid tablets were noted. Ultrasound is an excellent modality for the diagnosis and characterisation of these neuroectodermal anomalies. Its multiplanar imaging property along with real-time image visualization makes it an excellent tool for the diagnosis and characterization of these anomalies. KEYWORDS: Congenital neuroectodermal anomalies, Spina bifida, Hydrocephalus, Meningocele, Myelomeningocele, Ultrasound, Anencephaly

Sonographic evaluation of maternal kidneys in normal pregnancy

Background and Objectives: Renal disease can affect the outcome of pregnancy. The renal system undergoes significant physiological and anatomical changes during pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy. The purpose of this study was to sonographically evaluate the kidneys in normal pregnancy. Methods: A prospective descriptive study in which real time B-mode renal ultrasound was performed on 500 pregnant women attending for a routine obstetric ultrasound scan. Questions about the age, parity and presence of loin pain were asked. Obstetrical ultrasound examination was initially performed followed by examination of maternal kidneys. Results: Renal collecting system dilatation was the main abnormal finding; it was present in 18.2% of cases, (15.2% right side and 3% left side). Bilateral hydronephrosis was seen in (2.6%) of cases. Rate of hydronephrosis was more in primiparous women. Other findings were renal stones (2.8% right and 1.8% left sides, respectively), ureteric stone (0.2%) and acute pyelonephritis (1%). Conclusions: This study established the value of renal sonography in the pregnant women, though not a common condition. Renal collecting system dilatation was the main finding. A significant proportion of patients with asymptomatic renal calculi were detected incidentally.

Accuracy of sonographic fetal gender determination: predictions made by sonographers during routine obstetric ultrasound scans.

Objectives: The purpose of this study was to determine the accuracy of sonographer predictions of fetal gender during routine ultrasounds. Primarily, the study sought to investigate the accuracy of predictions made in the first trimester, as requests from parents wanting to know the gender of their fetus at this early scan are becoming increasingly common. Second and third trimester fetuses were included in the study to confirm the accuracy of later predictions. In addition, the mother's decision to know the gender was recorded to determine the prevalence of women wanting prenatal predictions. Methods: A prospective, cross sectional study was conducted in a specialist private obstetric practice in the Illawarra, NSW. A total of 640 fetuses across three trimesters were examined collectively by seven sonographers. Fetal gender was predicted using the sagittal plane only in the first trimester and either the sagittal or transverse plane in later trimesters. Phenotypic gender confirmation was obtained from hospital records or direct telephone contact with women postnatally. Results: Results confirmed 100% accuracy in predictions made after 14 weeks gestation. The overall success rate in the first trimester group (11–14 weeks) was 75%. When excluding those scans where a prediction could not be made, success rates increased to 91%. Results were less accurate for fetuses younger than 12 weeks, with an overall success rate of 54%. Male fetuses under 13 weeks were more likely to have gender incorrectly or unable to be assigned. After 13 weeks, success rates for correctly predicting males exceeded that of female fetuses. Statistical differences were noted in the success rates of individual sonographers. Sixty seven percent of women were in favour of knowing fetal gender from ultrasound. Publicly insured women were more likely to request gender disclosure than privately insured women. Conclusions: Sonographic gender determination provides high success rates in the first trimester. Results vary depending on sonographer experience, fetal age and fetal gender. Practice guidelines regarding gender disclosure should be developed. Predictions prior to 12 weeks should be discouraged.