Trimester Ultrasonography Research Articles

Correlation of Placental and Fetal Liver Morphometry in 2nd and 3rd Trimester Ultrasound Findings

Correlation of Placental and Fetal Liver Morphometry in 2nd and 3rd Trimester Ultrasound Findings

Research protocol - Evaluating data quality in the Netherlands Perinatal Registry (Perined): A data comparison study using hospital records from the IUGR Risk Selection (IRIS) study

Background The quality of registry based studies depends largely on the data accuracy of the registries. The Dutch Perinatal Registry (Perined) is a nationwide database comprising perinatal data digitally provided by different healthcare providers. Perined data are used for comparing outcomes across regions and healthcare institutions as well as for quality analyses and research purposes. However, little is known about the data quality of the Perined database. Therefore, the aim of this study is to assess the quality of Perined data compared to hospital records and case report forms (CRFs) that were part of the IUGR Risk Selection (IRIS) study. Methods In this comparison study data from Perined and the IRIS Study will be used. The IRIS study was a large cluster-randomized trial investigating the effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcomes among Dutch low-risk pregnant women. A subsample of the IRIS study of neonates being at risk of severe adverse perinatal outcomes and their mothers will be used. Baseline demographic data were collected by midwives from participating women at inclusion (around 22 weeks’ gestation) using CRFs, and in-depth neonatal and maternal clinical data were retrieved from hospital records by trained research assistants. These latter IRIS study data were linked and compared to Perined data. Completeness of Perined data will be calculated for every variable. The reliability will be assessed as the percent of agreement between Perined and hospital record data or the CRF-based data. Additionally, intra-class correlation coefficients will be calculated for continuous variables, and Kappa and ‘Prevalence-and-Bias-Adjusted Kappa’ will be calculated for categorical variables. Discussion The results of the proposed comparison study will provide users of Perined data insight in its data quality. This will serve as an example of the accuracy of registry based data used in maternal and neonatal care research.

Co-Twin Prognosis After Single Intrauterine Fetal Death at a Tertiary Care Hospital in India: A Retrospective Observational Study.

Twin pregnancy is associated with an increased risk of perinatal morbidity. Besides, if intrauterine death of a single twin occurs, it increases the morbidity of the surviving co-twin perinatally and postnatally. The objective of this study was to determine the incidence of single intrauterine fetal death (SIUFD) in a twin pregnancy and fetal outcome defined in dimensions according to the complications in the surviving co-twin. Data on twin pregnancies were collected retrospectively for a period of five years (from 2015 to 2019) from the labour room records of the Central Records Department (CRD) at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Cases with SIUFD were studied individually and neonatal follow-up was taken post delivery for up to three to eight years. Inclusion criteria were SIUFD in twin pregnancies after 14 weeks gestation, chorionicity pre-defined by early trimester ultrasonography. Exclusion criteria were higher-order pregnancy and monoamniotic twins. A total of1246 (4.273%) twin deliveries were conducted in the study period. Of these, 107 (8.587%) pregnancies had SIUFD with co-twin surviving in utero. Among these, 77 (72%) were dichorionic diamniotic (DCDA) twin pregnancies and 30 (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The incidence of SIUFDwas 8.5%. Preterm birth was the most common complication observed in our study and was found in 53.5% and 58.3% of participants in DCDA and MCDA twins, respectively. Early neonatal death (within 24 hours of life) of the surviving twin was found in 29.2% monochorionic twins with SIUFD. SIUFD at < 28 weeks gestation led to a greater number of early neonatal deaths of surviving twins. The incidence of neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy) in our population after birth was 7.5% (n=93). Twin pregnancies with SIUFD have an increased incidence of preterm labour, increased neonatal death of the surviving twin, and neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy). Monochorionicity and SIUFD at <28 weeks gestation are associated with increased neonatal deaths in co-twin. The Incidence of neurodevelopmental disorders is not directly associated with chorionicity, but developmental delay is more profoundly seen in the monochorionic group.

Investigating the Relationship between Serum Levels of PAPP-A and Free β-hCG in the First Trimester of Pregnancy with Placental Thickness and Percentile of Fetal Weight in Third Trimester Ultrasound

Investigating the Relationship between Serum Levels of PAPP-A and Free β-hCG in the First Trimester of Pregnancy with Placental Thickness and Percentile of Fetal Weight in Third Trimester Ultrasound

Examining Fetal Growth Biometrics and Last Menstrual Period Correlation in Minangkabau Ethnicity during Third Trimester Ultrasound

Background Fetal growth significantly impacts well-being and health outcomes at birth, exerting a profound influence on the occurrence of perinatal complications and mortality rates. Aim This study aims to establish normal fetal growth data based on biometric variations in the Minangkabau ethnic group. Methods An analytical cross-sectional study focusing on pregnant women who underwent pregnancy check-ups was conducted in December 2020. Results A total of 520 pregnant women had third trimester ultrasounds. Most were aged 21-39 with one parity, had a senior high school education, and were unemployed. The strongest correlation (R=0.86) was between the last menstrual period (LMP) and biparietal diameter (BPD), while the weakest (R=0.79) was between LMP and head length (HL). All variables were highly significant (p&lt;0.05). Conclusions Fetal growth biometrics (BPD, FL, HC, AC, and HL) were associated with LMP of third trimester ultrasound pregnancy on Minangkabau ethnic.

To know or not to know: Effect of third-trimester sonographic fetal weight estimation on outcomes of large-for-gestational age neonates.

The aim of the present study was to evaluate the impact of late third-trimester sonographic estimation of large for gestational age fetuses on pregnancy management and selected fetal and maternal adverse outcomes. A retrospective cohort study was conducted in a tertiary, university-affiliated medical center between 2015 and 2019. All singleton large-for-gestational-age neonates born during this period were included. The cohort was divided into two groups: neonates for whom fetal weight was estimated on late third trimester (<14 days before delivery) sonography and neonates with no recent fetal weight estimation. The groups were compared for pregnancy management strategies, rates of labor induction, cesarean deliveries, and maternal and neonatal outcomes. A total of 1712 neonates were included in the study, among whom 791 (46.2%) had a late third-trimester fetal weight estimation (study group) and 921 (53.8%) did not (control group). Compared to the control group, the study group was characterized by higher rates of maternal primiparity (24.20% vs 19.20%, P = 0.013), higher maternal body mass index (26.0 ± 6.2 kg/m2 vs 24.7 ± 4.5 kg/m2, P = 0.002), more inductions of labor (29.84% vs 16.40%, P < 0.001) and cesarean deliveries (31.0% vs 19.97%, P < 0.001). There were no clinical differences in neonatal birth weight (4041 ± 256 g vs 3984 264 g, P < 0.001) and no significant differences between other neonatal outcomes, as rates of admission to the neonatal intensive care unit, jaundice, hypoglycemia, and shoulder dystocia. Late third-trimester sonographic fetal weight estimation is associated with a higher rate of labor induction and planned and intrapartum cesarean deliveries. In this retrospective cohort study, those interventions did not lead to reduction in maternal or neonatal adverse outcomes.

Study of vesicular mole and its outcomes

Vesicular mole is defined as the premalignant form of gestational trophoblasticneoplasia. I5-20% of complete moles and &amp;#60;5% of partial moles will develop into Gestational Trophoblastic Neoplasia. It is of clinical and epidemiological interest because of its potential for significant consequences on women's health. The study aims to determine the incidence, outcomes and complications of pregnancy with vesicular mole at SKNMC hospital, Pune. It was a retrospective study. Approval for the study was obtained from institutional ethical committee. Data was collected from OPD, OT register and Indoor patient record file from August 2015 to August 2020. Proformas were filled. All the collected data was compiled in a master chart, analysed and outcomes of different variables under study have been expressed in the form of mean, frequencies, percentages and charts. The incidence of molar pregnancy was 0.17% or 1 in 561 deliveries. Vesicular mole occurred more in the age group 16 to 25 years, was lowest in age group 31-35yrs. Vesicular mole was most common in nulliparous women. The mean gestational age of the patients at presentation was 9.4 week. Hemorrhage after suction and evacuation was seen in 26% cases needing intra and post-operative blood transfusion. 6% of patients developed thyrotoxicosis. During follow up invasive mole was diagnosed in 2 cases (6%). The case fatality rate is 2.9% in our study. 1 patient (3%) developed choriocarcinoma and died within 6months after hysterectomy and chemotherapy. The incidence of 1 in 561 deliveries which is higher than non-Asian countries 1/752 but lower than other Asian countries 1/387. The routine first trimester ultrasonography helps in early detection of asymptomatic women. If not followed up regularly it can be life threatening.

Placenta percreta in first trimester – A rarity and diagnostic dilemma

The diagnosis of placenta accreta spectrum (PAS) in pregnancy is associated with severe maternal complications and is potentially life threatening. Moreover, PAS is difficult to diagnose in the first trimester, and the accuracy is low. A prenatal diagnosis is pivotal for planning an optimal management in PAS. A first trimester US(Ultrasound) can detect PAS in good proportion of cases, although the sensitivity is lower than a second or third trimester US. An early first trimester US can further help predict severity of PAS and its surgical outcome. As the management and diagnosis remains a challenge as far as PAS in early pregnancy is concerned, a high clinical suspicion especially in cases of previous uterine scar and bleeding following a surgical evacuation cannot be overemphasised. We report a case of Placenta Percreta in First Trimester, its rarity and diagnostic dilemma.

1119 Routine use of the Detailed First Trimester Ultrasound (DFTU) and Associated Outcomes

1119 Routine use of the Detailed First Trimester Ultrasound (DFTU) and Associated Outcomes

Evaluation of Atrioventricular Valve Regurgitation in Detection of Atrioventricular Septal Defects at First Trimester Ultrasound

Evaluation of Atrioventricular Valve Regurgitation in Detection of Atrioventricular Septal Defects at First Trimester Ultrasound

1124 Reproductive Outcomes with Universal Detailed First Trimester Ultrasound

1124 Reproductive Outcomes with Universal Detailed First Trimester Ultrasound

A Case Report: MRI versus Ultrasonography in Abdominal Pregnancy, Which One is Better?

Abdominal pregnancy is a rare potentially life-threatening form of ectopic pregnancy. First trimester sonography is very useful to identify an abdominal pregnancy earlier. However, cases of undiagnosed abdominal pregnancy at second and third trimesters are still reported in obstetric practice. Abdominal pregnancy is often missed during routine ultrasound examination that has classical findings such as the absence of myometrial tissue between the maternal bladder and the pregnancy, an empty uterus, poor visualization of the placenta, oligohydramnios, and abnormality of fetal lie. Magnetic Resonance Imaging (MRI) has been reported as the best abdominal pregnancy detection modality in a later gestational age due to its ability in detailing vascular and placental organ invasion. The reporting of a case of a patient with an abdominal pregnancy involves a diagnosis using abdominal ultrasound in the second trimester. A 38-year-old woman was admitted to RSUP Dr. Hasan Sadikin Bandung with suspected abdominal pregnancy at gestational age of 28 weeks. Due to unclear clinical manifestation, the diagnosis of abdominal pregnancy was not detected and there was a plan for vaginal termination of pregnancy by misoprostol induction in the hospital before. The patient complained about progressive abdominal pain and difficult of defecation for 2 months before and this condition worsened in the last 4 days. Ultrasound examination in RSHS revealed that there were one living fetus, extra-uterine pregnancy with estimated fetal weight of 664 grams, fetal heart rate (+), and transverse breech presentation. Congenital abnormality was difficult to assess due to oligohydramnios. MRI was performed and showed intra-abdomen pregnancy with one living fetus, breech presentation, and intact amniotic membrane with oligohydramnios which was superior to the uterus and attached along the anterior aspect of uterus. The placenta had the size os 11.52 x 7.02 x 13.07 cm, was diffusely heterogenous in shape, on the right superoanterolateral wall of the gestational sac, and seemed to be attached to the right anterior abdominal wall and part of the intestine in the superior part while no placental adherence was seen. The patient was successfully treated with exploratory laparotomy with complete removal of the fetus and placenta. This case was reported to compare the advantage of MRI and ultrasound examination in detecting abdominal pregnancy, especially in late gestational age.

The Role of First Trimester Ultrasound in the Detection of Vasa Previa: a Systematic Review

Vasa previa is a rare disorder in which fetal blood vessels are left unprotected in the membranes and cross the internal os of the cervix. The risk of vessel tearing causing antepartum bleeding and fetal death due to exsanguination is highly increased. Prenatal detection drastically improves fetal outcome. The aim of this study is to scrutinize the recent evidence for the use of first trimester prenatal ultrasonography to improve the detection of vasa previa. We conducted a systematic literature review in the computerized databases Pubmed, Embase, CINAHL and Web of Science from inception to September 2022. Two first trimester sonographic markers are associated with vasa previa later in pregnancy: umbilical cord insertion in the lower one-third of the uterine cavity and a velamentous insertion. We conclude the evaluation of the umbilical cord insertion in the first trimester is feasible, not time-consuming and may identify the population at increased risk for vasa previa.

First Trimester Ultrasound and Aneuploidy Screening in Twins.

All patients with twin pregnancy should have first trimester ultrasound and be offered screening for chromosomal aneuploidy as well as diagnostic testing. Screening for aneuploidy in twins presents unique challenges compared with singletons. Cell-free DNA screening should be considered first-line; however, this option may not be available or may have limitations in certain clinical scenarios, such as vanishing twins. If cell-free DNA screening is not available, maternal serum marker screening in conjunction with nuchal translucency assessment should be offered. Patients with positive aneuploidy screening tests or fetal structural abnormalities should be offered diagnostic testing.

The Impact of Maternal Obesity on Neonatal Outcomes of Pregnancies Complicated by Fetal Growth Restriction.

This study aimed to characterize the relationship between maternal obesity, fetal abdominal size, and neonatal morbidity in pregnancies complicated by fetal growth restriction (FGR). Pregnancies complicated by FGR, which resulted in delivery of a live, singleton, nonanomalous infant at a single center between 2002 and 2013 were identified in a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Pregnancies complicated by diabetes were excluded. Fetal biometry measurements from third trimester ultrasounds performed at the same institution were extracted from another institutional database. Pregnancies were divided into cohorts based on fetal abdominal circumference (AC) gestational age percentile (<10th centile, 10-29th centile, 30-49th centile, and ≥50th centile) at the ultrasound closes to the date of delivery. Obesity was defined by prepregnancy body mass index >30 kg/m2. The primary outcome was a composite of neonatal morbidity (CM) including 5-minute Apgar < 7, arterial cord pH <7.0, sepsis, respiratory support, chest compressions, phototherapy, exchange transfusion, hypoglycemia requiring treatment, or neonatal death. Outcomes were compared between women with versus without prepregnancy obesity overall and then stratified by AC cohort. A total of 379 pregnancies met criteria; CM occurred in 136 (36%). Overall, there was no difference in CM between infants born to women with versus without obesity (risk ratio (RR): 1.11, 95% confidence interval: 0.79-1.56). When stratified according to AC at ultrasound closest to delivery, there was higher prevalence of CM occurring among women with prepregnancy obesity than those without prepregnancy obesity when the fetal AC was >50th or 30 to 49th centile However, these differences did not reach statistical significance. Our study identified no significant difference in risk of CM among growth-restricted infants of obese versus nonobese mothers, including among infants with very small AC. More research is needed to further examine the potential relationships postulated here. · No significant differences in neonatal outcomes of FGR pregnancies in obese versus nonobese patients.. · No significant differences in AC percentile distribution in FGR pregnancies in obese versus nonobese.. · Pregnancies complicated by obesity had a higher need for cardiac support but not chest compressions..

Artificial Intelligence and the second trimester of pregnancy: A literature survey

Pregnancy is a wonderful period in every woman’s life. Every trimester comes with all sorts of emotions, good or bad. The second trimester is said to be the most pleasant one. Nevertheless, it comes with anxiety and stress. To eliminate these emotions, doctors perform a second trimester ultrasound. This is also called the second trimester morphology scan. This type of scan is important because it determines if the fetus is growing and developing at normal pace. The sonographer measures the baby’s size and weight, the fetal heart, brain, spine, skeleton, abdominal, pelvic, and thoracic organs. She/he also checks whether there are hard or soft genetic disorders markers, whether the amniotic fluid levels are normal or not, and determine the location of the placenta. All these verifications and estimations imply a good experience in fetal ultrasonography. Unfortunately, experienced sonographers are clustered in big city cities, and cannot be found in poor regions. In order for everybody to have access to premium fetal morphology ultrasounds, there is a need for artificial intelligence methods. Artificial Intelligence algorithms can signal possible anomalies, which an unexperienced sonographer might miss. The aim of this paper is to do a literature survey and present the state-of-the-art of the Artificial Intelligence applied in second trimester sonography.

Prediction of Monochorionic Diamniotic Twin Pregnancy Outcomes Based on Early Second Trimester Ultrasound

Background: Association between second trimester ultrasound findings and twin pregnancy outcome is still unclear. Study aimed to evaluate the performance of second trimester ultrasound scan in the prediction of monochorionic diamniotic twin pregnancies outcomes. Methods: Prospective-cohort study of all consecutive healthy women with monochorionic twin pregnancies followed-up and delivered in five years was undertaken. During second trimester screening (16–18 weeks) fetal biometry was measured (biparietal diameter–BPD, abdominal circumference–AC, femur length–FL, estimated fetal weight–EFW) and inter-twin discordance noted. Amniotic fluid amount was determined. Pregnancy outcomes were having live-born twins, Apgar sores and birth-weights, pregnancy complications and gestational week of delivery. Results: Receiver operating characteristics (ROC) analysis showed that BPD (p = 0.018), AC (p = 0.019) and FL (p = 0.015) were good predictors of having live-born twins. Regression analysis showed that the most important factors influencing twins’ survival to term were inter-twin AC, BPD and FL differences. Fetal discordance in BPD, AC and FL explained correctly 76.3%, 76.5% and 58% of pregnancy outcomes. If second trimester inter-twin BPD difference was &lt;2.5 mm, AC difference was &lt;17 mm and FL difference was &lt;1.5 mm survival of twins was better, complications were less frequent, delivery mostly occurred closer to term, twins had higher birth-weights and better Apgar scores. Second trimester EFW of twin and its difference as well as the amniotic fluid amount were not associated with examined pregnancy outcomes. Conclusions: Discordant twins’ growth in the second trimester registered by ultrasound reliably implies on adverse monochorionic diamniotic twin pregnancy outcome.

Routine third trimester ultrasonography in predicting adverse perinatal outcomes: a prospective cohort study at a tertiary-care hospital in Eastern India.

Fetal growth restriction (FGR) may go undetected in the antenatal period with subjective clinical evaluation, and there is a growing propensity to perform a third-trimester scan, especially in the developed countries. The literature on the importance of the same in developing countries like ours, is scant. Hence, this study was undertaken to evaluate the role of routine third-trimester ultrasonography along with Doppler in predicting adverse perinatal outcome. A prospective cohort study was conducted at a tertiary-care hospital, in which routine third-trimester ultrasonography was performed for 265 antenatal women, and included estimation of amniotic fluid index (AFI), estimated fetal-weight (EFW), and cerebroplacental ratio (CPR). Women were categorized as having normal parameters or having at least one abnormal parameter. Post-natal adverse perinatal outcomes including low birth-weight, hypoglycemia, poor Apgar scores, prolonged hospital stay, need for ventilatory support, neonatal asphyxia, neonatal sepsis and early neonatal death were recorded. Prediction analyses for sensitivity, specificity, positive and negative predictive values were done. Receiver Operating Characteristic (ROC) curves were plotted for threshold for each parameter for adverse outcome. Out of 260 women that were analyzed, 47.5% had no clinically identifiable risk factors, and 52.5% had at least one abnormal parameter. Sensitivity and negative predictive value for adverse outcome were highest for composite ultrasound finding (85.4% and 90.4% respectively). Specificity, positive predictive value and diagnostic accuracy were highest for CPR (97.8%, 86.7% and 76.9% respectively). Routine third trimester ultrasonography, including Doppler, can help in risk-stratification of otherwise clinically low-risk pregnancies.

Third Trimester Ultrasound Stratifies Risk of Peripartum Complications in Pregnancies Complicated by Impaired Glucose Tolerance.

The objective of our study was to investigate the effect of impaired glucose metabolism (IGM) and ultrasound (US) findings consistent with hyperglycemia on maternal and neonatal outcomes. This was a retrospective case-control study of singleton, nonanomalous pregnancies with an elevated 1-hour glucose screening test (GST) completed after 23 weeks of gestation. IGM was defined as a 1-hour GST of >130, but less than two abnormal values on 3-hour glucose tolerance test (GTT). Gestational diabetes was defined as two or more abnormal values on 3-hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference >95th centile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (impaired glucose metabolism consistent with ultrasound findings [IGM-US]) and those without IGM. Maternal demographics, delivery outcomes (gestational age at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage, and neonatal outcome (birth weight centile [BW%], neonatal intensive care unit admission, hypoglycemia, and glucose) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and gestational diabetes mellitus (GDM). Odds ratios were calculated and adjusted for maternal age, BMI, and gestational weight gain. A total of 637 individuals with an abnormal 1-hour GST were included (122 with IGM-US, 280 with IGM, and 235 with GDM). When compared to the IGM group, IGM-US had higher rates of cesarean delivery and BW% > 90th centile at delivery (adjusted odds ratio [aOR]: 1.7 [1.1-2.8] and aOR: 5.9 [2.7-13.0], respectively). Individuals with GDM also demonstrated similar rates with BW% > 90% but not cesarean section(aOR: 3.9 [1.8-8.5] and aOR: 1.4 [0.9-2.1], respectively). The remaining maternal and fetal outcomes were similar. Women with impaired glucose tolerance should have a third-trimester ultrasound to identify an increased risk of perinatal complications. · Women with elevated blood glucose screening should be evaluated with third-trimester ultrasound to identify risks for perinatal morbidity.. · The third-trimester ultrasound identifies individuals at risk for cesarean section.. · Counseling should be completed with individuals with polyhydramnios or accelerated growth..

Changes in prenatal testing during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic. Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds. The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p < 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey <20 weeks' gestation across datasets, which did not persist at <23 weeks' gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p < 0.001) but not Highmark. Findings were similar with multivariable adjustment. While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic.