Trimester Ultrasonography Research Articles

PREGNANCY OUTCOME OF WOMEN WITH PREVIOUS CESAREAN SECTION ACCORDING TO PLACENTAL LOCATION IN FIRST TRIMESTER SONOGRAPHY

Moreover, the first trimester ultrasonography provides a valuable e valuation for predicting pregnancy outcomes. Our purpose was to determine whether ultrasonography of placental location at 11 - 14 weeks of gestation (first trimester) can predict neonatal and maternal pregnancy outcomes. The observational and prospective st udy from July 2011 to October 2012 was conducted on the 200 pregnant women with previous cesarean. Placental locations were determined by ultrasonog raphy at 11 - 14 weeks’ gestation, and then were classified into four groups including anterior high , anterior low , posterior high and posterior low. Parameters such as Preterm Labor, Preterm Premature Rupture of Membrane , neonatal Birth Weight , occurrence of bleeding throughout pregnancy were followed up. Our results showed that the anterior low group had highest rate of bleeding throughout pregnancy compared with groups of posterior low, anterior high and posterior high (40 %, 34 %, 4 %, 6 %, respectively, p < = 0.001); furthermore, there was significant correlation between rising the number of previous cesareans and increasing the incidence of the anterior low placental implantation (P value = 0.03). Anterior low group had lowest average of neonatal birth weight (p - value < 0.001), while anterior high group had highest average of neonatal birth weight compared wit h other groups. We believe that the ultrasound procedure was valid and enabled us to evaluate the pregnancies at first stages of pregnancy (11 - 14 weeks ) . Therefore, it can be used in evaluating the pregnancies to categorize them as being at risk for an adv erse ante partum, intra partum and neonatal outcomes.

First Trimester Ultrasound in Prenatal Diagnosis-Part of the Turning Pyramid of Prenatal Care.

First-trimester sonographic assessment of the risk of chromosomal abnormalities is routinely performed throughout the world, primarily by measuring fetal nuchal translucency thickness between 11–13 weeks’ gestation, combined with assessment of serum markers. The development of high-frequency transvaginal transducers has led to improved ultrasound resolution and better visualization of fetal anatomy during the first-trimester. Continuous improvement in ultrasound technology allows a thorough detailed assessment of fetal anatomy at the time of the nuchal translucency study. Using transabdominal or transvaginal sonography, or a combination of both approaches, it is now possible to diagnose a wide range of fetal anomalies during the first trimester. Multiple studies reported early diagnosis of major fetal anomalies after demonstrating the association of increased nuchal translucency thickness with structural defect in chromosomally normal and abnormal fetuses. Normal sonographic findings provide reassurance for women at high risk while detection of fetal malformation during the first trimester enables discussion and decisions about possible treatments and interventions, including termination of pregnancy, during an early stage of pregnancy.

P05.12: Diagnosis of fetal structural abnormalities at the 11–14 week scan in a tertiary Fetal Medicine Unit

Ultrasound (US) exam in the first trimester allows the detection of many malformations, dysplasias, deformations and genetic syndromes, besides screening for chromosomal anomalies using classical markers as nuchal translucency (NT), ductus venosus and nasal bone. A total of 8783 pregnant women referred to a tertiary Fetal Medicine Center between 11 and 13 6/7 weeks of gestation were submitted to an US exam, including anatomy study and measurement of NT and other ultrasound markers for trisomies. All patients were followed until delivery, when the sonographic findings were compared to the clinical and/or pathological findings. Isolated abnormal NT were not included. First trimester scans detected 231 structural anomalies (2,9%), and 29,6% of the total defects. Most frequent diagnosis were: acrania/exencephaly, hidropsy, cystic hygroma, bladder outlet obstruction, omphalocele, gastroschisis, holoprosencephaly and Body-Stalk anomaly. First trimester US screening has a very good potential for detection of fetal structural abnormalities, but the second trimester US screening remains important to improve prenatal care.

Imaging the first trimester heart: ultrasound correlation with morphology.

First trimester sonography is a widely used technique to examine the foetus early in pregnancy. The desire to recognise complex anatomy already in early developmental stages stresses the need for a thorough knowledge of basic developmental processes as well as recognition of cardiac compartments based on their morphology. In this paper, we describe the possibilities and limitations of sonographic assessment of the foetal heart between 10 and 14 weeks of gestation and correlate this to morphology. Examples of the most commonly detected congenital anomalies are atrioventricular septal defects, transposition of the great arteries, and hypoplastic left heart, which are shown in this paper.

Accuracy rate of sex determination in the first trimester ultrasonography

Accuracy rate of sex determination in the first trimester ultrasonography

Birinci trimester ultrasonografisinde cinsiyet tayini doğruluk yüzdesi

Birinci trimester ultrasonografisinde cinsiyet tayini doğruluk yüzdesi

PA.44 How will the updated March 2013 RCOG Green-top Guideline ‘The Investigation and Management of the Small-for-Gestational-Age Fetus’ impact our antenatal maternity services? Will there be a service provision gap impacting our ability to adhere to the recommended guidance?

IntroductionSmall for gestational age (SGA) fetuses are at increased risk of perinatal morbidity and mortality. The new RCOG SGA Guideline recommends screening for minor and major risk factors at booking...

First Trimester Ultrasound Assessment for Fetal Aneuploidy

Screening tests for trisomy 21 have gradually become more refined and now involve complex statistical models that combine demographic, biophysical, and biochemical parameters to produce individualized risk estimates for pregnant women. An understanding of the evolution of the principles, methods, and statistical techniques applied to Down syndrome screening is valuable as these processes can be transferred to other, more prevalent, adverse pregnancy outcomes. First trimester ultrasound forms the foundation of this process.

Second Trimester Ultrasound Markers of Fetal Aneuploidy

Although it is widely accepted that the best time to screen for chromosomal abnormalities is the first trimester, ultrasound evaluation of the fetus in the second trimester has also been shown to be useful for this purpose. A multitude of markers of varying strength has been developed over the past 30 years. In addition, the optimal time to diagnose fetal anomalies with confidence is also the mid second trimester. Therefore, performance of obstetrical ultrasound at this point in gestation continues to be an important component of prenatal care.

Stillbirth: The heart of the matter

We evaluated 2,083 cases within the Wisconsin Stillbirth Service Program (WiSSP) that had autopsy reports or ultrasound data relevant to the heart. Of these, 167/1,782 (9.4%) stillbirths after 20 weeks and 11/301 (3.7%) miscarriages <20 weeks had congenital heart disease (CHD). Cases were classified by type of heart defect and whether it related to cause of death. Among cardiac anomalies that contributed significantly to fetal death, 125/151 (83%) were associated with underlying conditions or syndromes, nearly half of which were chromosomal. The most common forms of CHD in stillborns were severe cyanotic lesions (3%), then ventricular (2.6%) and atrial (1.9%) septal defects. Compared to livebirths, this represents a shift toward more severe cardiac lesions, although all comparable categories, including non-lethal conditions such as atrial septal defect, are more common in stillbirths. Clinical cardiomyopathy was identified as cause of death in 1.2% of stillborns. Cardiomegaly, occurring in 26.7% of all cases and 76.7% of infants born to diabetic mothers, may represent undiagnosed cardiomyopathy and/or may decrease fetal tolerance of hypoxia. In contrast, 78.5% of Turner syndrome infants, all <32 weeks, had small hearts. More attention to cardiac findings can lead to increased understanding of stillbirth causes. Based on our findings, we recommend chromosome studies on all stillbirths and close attention to the heart during second trimester ultrasounds, with chromosome studies offered if CHD is found. Consideration of heart size can result in prenatal identification of infants at risk for stillbirth, particularly large hearts in fetuses of diabetic mothers in the third trimester, which may identify fetal cardiomyopathy before it becomes life-threatening.

A Randomized Controlled Study to assess the Role of Routine Third Trimester Ultrasound in Low-risk Pregnancy on Antenatal Interventions and Perinatal Outcome

ABSTRACT Objective To assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome. Design Randomized controlled study. Setting KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum. Subjects A total of 290 low-risk pregnant women between 34 and 37 weeks attending antenatal clinic and fulfilling inclusion criteria were allotted using computer-generated randomization numbers into study and control groups. Intervention In study group, third trimester ultrasound was performed to assess fetal growth, amniotic fluid index (AFI), malpresentations, and late onset fetal anomalies. In control group, no routine ultrasound was performed, unless indicated by clinical suspicion during subsequent visits. High-risk fetuses identified were managed as per the standard protocol. All women were followed to assess antenatal interventions, intrapartum events and perinatal outcome. Results Detection of high-risk fetuses antenatally in study and control groups was 17.25 and 2.07% respectively. This difference was statistically significant (p = —0.0001). Rates of antenatal interventions among study and control were 24.8 and 4.44% respectively. Prevalence of small for gestational age (SGA) fetuses among study and control was 6.9 vs 11.03% respectively. This difference was not statistically significant (p = —0.253). There was no statistical difference in adverse intrapartum events, cesarean section rate for nonreassuring cardiotocography (CTG), low Apgar score and neonatal intensive care unit (NICU) admissions among study and controls. Conclusion Routine third trimester ultrasound is a logical solution for detection of high-risk fetuses in low-risk pregnancies which would otherwise be missed by clinical examination. However, this leads to an increase in antenatal interventions without significantly influencing the perinatal outcome. How to cite this article Revankar KG, Dhumale H, Pujar Y. A Randomized Controlled Study to assess the Role of Routine Third Trimester Ultrasound in Low-risk Pregnancy on Antenatal Interventions and Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(3):139-143.

The importance of a late first trimester placental sonogram in patients at risk of abnormal placentation.

Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality. This report highlights risk factors, early diagnostic findings and complications associated with placenta accreta, and the role of first trimester sonography in diagnosis. Case. A 38-year-old pregnant woman, G2P1L1 with history of one previous Caesarean section, presented with vaginal bleeding at 13 weeks' gestation. Ultrasound examination was highly suspicious of placenta previa with accreta. During an earlier 12-week scan for nuchal translucency measurement, the placenta was suboptimally visualized. She was counselled regarding potential maternal and fetal complications as well as management options. At 33 weeks' gestation Caesarean hysterectomy was performed due to vaginal bleeding. Conclusion. Early ultrasound screening in high-risk patients may be advantageous in order to identify placenta accreta and conduct appropriate patient counseling regarding risks and management options.

155: Assessment of the number of umbilical cord vessels at the time of nuchal translucency screening

Objective: To investigate feasibility of identifying the number of vessels in umbilical cord during nuchal translucency screening. Methods: We performed a prospective study in patients undergoing nuchal translucency screening at 11.0-13.9 weeks’ from 2011-2012. An oblique transverse view of fetal abdomen utilizing Doppler flow and a cross section view of free loop of umbilical cord were obtained. Maternal characteristics, technical aspects of first trimester ultrasound, and number of umbilical cord vessels identified in the second trimester were collected. McNemar’s test and kappa analysis were used to compare quantification of umbilical cord vessels in the first vs. second trimesters. Results: Total of 123 women were included. The number of umbilical cord vessels was successfully visualized in 95.9% of patients utilizing the bladder view, and 65.0% of patients on cross sectional cord views. Three-vessel cord was correctly identified in 99.2% of patients; one case was incorrectly diagnosed with a two two-vessel cord. McNemar’s test indicated that overall, first and second trimester ultrasounds have the same propensity to detect umbilical cord vessels (p=0.414), with moderate agreement (kappa=0.226). Conclusions: Identification of umbilical cord vasculature is possible in the first trimester and can be used as an adjunct to early fetal anatomy evaluation.

Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging

PurposeTo determine if women with leiomyomata detected using uniform ultrasound methods are at increased risk of cesarean birth, without regard to indication. MethodsWomen were enrolled in Right from the Start (2000–2010), a prospective pregnancy cohort. Leiomyomata were counted, categorized, and measured during first trimester ultrasounds. Women provided information about demographics and reproductive history during first trimester interviews. Route of delivery was extracted from medical records or vital records, if the former were unavailable. Generalized estimating equations were used to calculate risk ratios (RR) and 95% confidence intervals (CIs) for the risk of cesarean birth by leiomyoma presence and characteristics. ResultsAmong 2635 women, the prevalences of leiomyomata and cesarean birth were 11.2% and 29.8%, respectively. Women with leiomyomata, compared with those without, had a 27% increase in cesarean risk (RR, 1.27; CI, 1.17–1.37). The association was weaker following adjustment for maternal body mass index and age (adjusted risk ratio [ARR], 1.11; CI, 1.02–1.20). The adjusted risk was elevated for women with a single leiomyoma 3 cm or more in diameter (ARR, 1.22; CI, 1.14–1.32) and women with the largest total leiomyoma volumes (ARR, 1.59; CI, 1.44–1.76). ConclusionsWomen with leiomyomata were at increased risk for cesarean birth particularly, those with larger tumor volumes.

A pictorial guide for the second trimester ultrasound.

Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements. Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.

Bifid choroid plexus: Always a normal fetal brain structure variant?

Choroid plexus, a fetal organ developing approximately from the sixth week of gestation, plays a fundamental role in developing fetal brain organization. As relatively little is known about the relationship between anomalies of choroid plexuses structure and their role in brain function, we examined cases of bifid choroid plexus (BCP) and discussed their potential association with lateral ventriculomegaly, other abnormal ultrasound findings, and their potential role as markers of fetal chromosomal abnormalities. In the present study, we described 23 cases of fetal BCP found in 2145 routine second trimester ultrasounds. For each patient 2D and 3D ultrasound volumes were acquired. BCP was defined as a choroid plexus whose body was divided into two portions (arms) differently located and oriented on the three spatial axes in correspondence to the lateral ventricle, in one or both sides. The entity of the separation and reciprocal orientation of the two arms was examined. The presence of BCP in a low-risk population of pregnant women undergoing routine second trimester ultrasound was showed. Lateral ventricles significantly increased in the presence of BCP. Malformations were found in four of 23 fetuses with BCP. Pregnancy outcome was favorable only in one of these four cases. We suggest that in the presence of mono or bilateral BCP without associated abnormal ultrasound findings, a closer look at fetal brain or extra-cranial structures is recommended. If no related abnormalities are found, serial prenatal and postnatal sonographic follow-up should be considered. In the presence of concomitant abnormal findings, genetic counseling, fetal karyotyping and magnetic resonance imaging, if possible by gestational age, are strongly advised.

Role of Nuchal Translucency in Detection and Management of Congenital Anomalies in First Trimester Sonography in Developing Countries

Variation of Nuchal Translucency (NT) measurements with increasing Crown-Rump Length (CRL). To correlate Nuchal Translucency with pregnancy outcome and clinical assessment of newborn for congenital anomalies. Antenatal ultrasound scanning done on pregnant women with singleton pregnancies and the fetal NT thickness was measured between 11 weeks and 13 weeks 6 days of gestation. Ultrasound probe used for transabdominal scanning was curvilinear probe with frequency band width of 3.5-5MHz. During the 11-13+6 weeks scan, the foetal CRL, Nuchal translucency, any structural abnormalities in the foetus, uterine anomaly, adnexa, cervix and the internal os were noted. In our study, we have done NT scan from 11 - 13+6 weeks of gestation; the mean examination time of the NT scan was 87.97 (12weeks 3days) standard deviation (SD)= 4.832. Subject study with high NT is 186 (16.6%) with 98.6% accuracy of association with congenital anomalies. Subject study with low NT is 936 (83.4%) with 99.8% of the babies born with no congenital anomalies. NT measurements increase with increasing CRL and a false positive rate increases with increasing gestational age. There is a strong association with high NT values and congenital anomalies.

Prenatal ultrasound exposure and association with postnatal hearing outcomes

ObjectivePrenatal ultrasound exams have become increasingly frequent. Although no serious adverse effects are known, the public health implications would be enormous should adverse effects on auditory development be shown. This study looks to establish a possible correlation between hearing loss and increased prenatal ultrasound exposure.DesignRetrospective cohort analysis.SettingTertiary academic referral center.MethodsA retrospective review of 100 children undergoing newborn hearing screening was conducted. Extensive data collection was performed, and this data was analyzed for a potential correlation between failure of newborn hearing screening and increased prenatal ultrasound exposure, as well as for a potential correlation of other variables with hearing loss.Main outcome measuresPostnatal hearing outcomes.ResultsA higher number of both total and 3rd trimester ultrasound exams as well as a younger gestational age at birth were all found to be significantly associated with a higher likelihood of passing the newborn hearing screen (p<0.001 for each). No other factors were found to reach statistical significance.ConclusionsOur results show that there is no correlation between a higher level of prenatal ultrasound exposure and hearing loss. Indeed, infants who had more prenatal ultrasounds in the third trimester were more likely to pass their screening hearing exams. The finding that children receiving more prenatal ultrasounds have a higher likelihood of passing newborn hearing screens serves as an excellent reminder of the classic statistics rule that correlation does not imply causation.

Second Trimester Ultrasound: Reference Values for Two-Dimensional Speckle Tracking–Derived Longitudinal Strain, Strain Rate and Time to Peak Deformation of the Fetal Heart

Data on myocardial deformation during the internationally widely used second-trimester screening are scarce and confusing. Reference values of time to peak strain are missing. The aims of this study were to assess reference values derived from two-dimensional speckle-tracking echocardiography for global and regional longitudinal right ventricular (RV) and left ventricular (LV) strain, strain rate, and time to peak global strain and to determine the influence of heart rate and gender on these strain parameters. Seventy-five healthy fetuses were enrolled during second-trimester ultrasound (20-24 weeks). Clips with high frame rates (mean, 132 frames/sec) and two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses. There were no statistically significant differences in global strain and strain rate between both ventricles (P= .679 and P= .734, respectively) or among the RV, septal, and LV free walls. Regional measurements, modeled also as an interaction of wall and segment (basal mid and apical), showed only a small, statistically significant difference between the basal RV and LV free walls. Strain and strain rate values were independent of heart rate. The mean time to peak LV global strain adjusted for heart rate was statistically significantly shorter than the RV value (P < .0001]). Strain, strain rate, and time to peak global strain were not found to be associated with gender. The establishment of second-trimester two-dimensional speckle-tracking echocardiographic reference values for global and regional strain, strain rate, and time to peak global strain in a healthy fetal cohort is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.

Utility of First Trimester Ultrasonography before 11 Weeks of Gestation: A Retrospective Study

We showed the utility of first trimester ultrasonography before 11 weeks of gestation for antenatal followup. We retrospectively analyzed 1295 records of patients who underwent first trimester ultrasonography (transvaginal/abdominal) in our antenatal clinic in Ankara, Turkey. Maternal age, parity, gestational age, and maternal gestational history were compared with ultrasonographic findings. Patients were divided into 12 groups based on ultrasonographic diagnoses in the first ultrasonographic scan, and called for a control examination within 10 days if the diagnostic findings were abnormal. The data were statistically analyzed using Kruskal-Wallis and chi-square tests. We noted 81.3% patients to have single, viable, intrauterine pregnancies, while 18.7% had abnormal or complicated pregnancies with uterine anomalies, ovarian cysts, fibroids, or subchorionic hematomas. Normal and anembryonic pregnancies had significantly lower median diagnostic period in the control ultrasonography than in the first examination. First trimester ultrasonography before 11 weeks of gestation is valuable in determining pregnancy outcomes.