Showing papers in "The Ultrasound Review of Obstetrics & Gynecology in 2004"
TL;DR: Four-dimensional sonography seems to be a useful imaging tool for clinical problem solving in perinatology, especially in observing the development of the central nervous system in utero.
Abstract: The aim of this paper was to review the clinical applications of four-dimensional ultrasonography in the assessment of fetal behavior. With the use of a computerized database, articles on three-dimensional ultrasonography were reviewed. Several applications of dynamic three-dimensional ultrasonography have been reported, including imaging of fetal movements, facial expression and fetal hand movements. The importance of the assessment of fetal behavior by four-dimensional sonography is stressed. Four-dimensional sonography seems to be a useful imaging tool for clinical problem solving in perinatology, especially in observing the development of the central nervous system in utero.
52 citations
TL;DR: Details of fetal hand/finger positioning and movement in early pregnancy in vivo are focused on and two cases with congenital hand/ finger malpositioning are presented.
Abstract: The recent advance of three-dimensional/four-dimensional ultrasound has clearly demonstrated details of fetal movement. Many musculoskeletal tissues and their innervation are associated with hand/finger positions and movements. This article focuses on details of fetal hand/finger positioning and movement in early pregnancy in vivo. From our data, mild adduction of the thumb and atonic fingers were observed from 11 weeks of gestation and the appearance of the palm was clearly different from that at 9 and 10 weeks. Fetuses start to clench and unclench their fists from 12 weeks and independent movement of each finger is occasionally seen from 13 or 14 weeks. In our series of fetuses with congenital central nervous system diseases, fetuses had normal hand/finger positioning and movements. We present two cases with congenital hand/finger malpositioning – one had an overlapping finger which was conspicuous after 13 weeks; the other had contractural malpositioning of the wrist demonstrated from 11 weeks. There m...
49 citations
TL;DR: The spectrum of disorders attributable to primary aberrations of the developmental program should increase dramatically in the next decades, in concert with the continuing explosion of neurobiologic insights into normal brain development.
Abstract: The spectrum of disorders attributable to primary aberrations of the developmental program should increase dramatically in the next decades, in concert with the continuing explosion of neurobiologic insights into normal brain development. Neurological disability is the most feared complication of pregnancy, labor and the neonatal period. The cause and effect relationship is often uncertain. The advent of 4D sonography and its application to study of fetal behavior have begun to provide insight into the structural and functional fetal brain development.
46 citations
TL;DR: It has been shown that the repertoire of fetal movements consists exclusively of motor patterns that can also be observed postnatally, and that there is a high degree of continuity of neural functions before and after birth.
Abstract: The development of the central nervous system (CNS) is traced through four overlapping processes: neurogenesis, migration, synaptogenesis and myelination. The complexity of CNS development reflects the complexity of sensomotor, cognitive, affective and behavioral development. One of the methods reflecting successful development of the CNS is investigation of behavioral patterns pre- and postnatally. After the immobile phase, the first fetal movements appear at 7.5–8 weeks with spontaneous trunk and limb vermicular movements. After several days general movements (GM) and startles appear, involving the trunk, head and limbs, with an expanding motor repertoire with increasing gestational age from 10 weeks onward. It has been shown that the repertoire of fetal movements consists exclusively of motor patterns that can also be observed postnatally, and that there is a high degree of continuity of neural functions before and after birth. However, the newborn's behavioral repertoire expands rapidly with patterns ...
19 citations
TL;DR: To study the utility of fetal heart rate (FHR) monitoring and actocardiogram for fetal diagnosis and the classification of fetal behavioral states, a comparison of the techniques and their results is undertaken.
Abstract: To study the utility of fetal heart rate (FHR) monitoring and actocardiogram for fetal diagnosis and the classification of fetal behavioral states, a comparison of the techniques and their results ...
18 citations
TL;DR: Fetal behavioral patterns throughout gestation and their correlation with structural developmental events are discussed in this review.
Abstract: During recent decades, the development of ultrasonic techniques has enabled the direct visualization of fetal life in utero. Real-time recording of fetal activity in various periods of gestation and the analysis of behavioral patterns have resulted in the detailed description of sequential changes in fetal behavior and provided information about the functional development of the fetal central nervous system. It is generally accepted that patterns of fetal activity reflect the development and maturation of the central nervous system. Therefore, the distinction between normal and abnormal fetal behavior could make possible the detection of discrete structural brain abnormalities. Fetal behavioral patterns throughout gestation and their correlation with structural developmental events are discussed in this review.
12 citations
TL;DR: In combination with fetal heart rate monitoring, two-dimensional ultrasound has been used in the third trimester to document the development of fetal behavioral states continuing from pre- to postnatal life.
Abstract: One of the central issues in developmental neurology is the need to formulate concepts helping to understand human behavior, which reflects the central nervous system from early intrauterine age to the young infant and even up to adulthood. Real-time ultrasound observations have been used from the early 1980s onwards to witness the origin, occurrence and developmental course of specific fetal movement patterns emerging during early prenatal life. A large variety of movement patterns has been observed: startles; general movements; breathing movements; head, trunk and extremity movements; jaw openings; yawning; sucking; swallowing; hiccups; and hand/face contacts. In combination with fetal heart rate monitoring, two-dimensional ultrasound has been used in the third trimester to document the development of fetal behavioral states continuing from pre- to postnatal life. In the early 1990s we started to perform longitudinal examinations in twin pregnancies observing similar movement patterns to those in single...
11 citations
TL;DR: In this paper, the first 40 years of fetal ultrasonography were discussed and a review of the first 20 years was published, focusing on the first three decades of fetal ultrasound.
Abstract: (2004). Fetal ultrasonography: the first 40 years. The Ultrasound Review of Obstetrics and Gynecology: Vol. 4, No. 3, pp. 141-147.
10 citations
TL;DR: This work investigated fetal learning from a behavioral development perspective assessed by a conventional parameter, i.e. eye movement patterns, and found that fetuses less developed required significantly more trials to show habituation than developed fetuses even at the same gestational age.
Abstract: Fetal behaviors gradually integrate into more complex movements in relation to each other along with functional central nervous system development. Investigating the ontogenesis of fetal behavior m...
8 citations
TL;DR: Four-dimensional sonography in multifetal pregnancies can be used for detection and evaluation of intertwin contacts, because it allows simultaneous visualization of both fetuses and assessment of their motor activity.
Abstract: Rapid improvements in the capacity of data processing due to technological breakthroughs in processor engineering is the basis of spatial imaging. Spatial imaging is the main benefit of three-dimensional sonography and it is used for visualization of fetal anatomy in three dimensions. Modern machines are capable of performing spatial imaging in near real time, called four-dimensional sonography. Four-dimensional sonography in multifetal pregnancies can be used for detection and evaluation of intertwin contacts, because it allows simultaneous visualization of both fetuses and assessment of their motor activity. The main benefits of four-dimensional sonography include: accurate recognition of an isolated motor activity of a single fetus; distinguishing between spontaneous and stimulated motor activity; and spatial visualization of the intertwin area.
7 citations
TL;DR: First-trimester ultrasonic evaluation, amniotic fluid assessment, monitoring of fetal growth, diagnosing the twin-to-twin transfusion syndrome, and assessment of fetal anomalies will be reviewed.
Abstract: With the increasing incidence of multifetal gestations, it is essential for the clinician to appreciate the benefit of ultrasound evaluation in these pregnancies. Multifetal gestation pregnancies are at increased risk for a range of both antepartum and intrapartum complications, such as intrauterine growth restriction, premature delivery, congenital anomalies, cord accidents, malpresentations, placenta previa, and abruptio placentae. First-trimester ultrasonic evaluation, amniotic fluid assessment, monitoring of fetal growth, diagnosing the twin-to-twin transfusion syndrome, and assessment of fetal anomalies will be reviewed. An early and accurate assessment of amnionicity and chorionicity are paramount in these gestations. The impact of chorionicity, in particular, can have profound consequences in the management of multifetal gestations. The determination of chorionicity onultrasonic evaluation in a multifetal gestations. The determination of chorionicity on ultrasonic evaluation in a multifetal pregnan...
TL;DR: Fetal echocardiography has emerged as an accurate tool to diagnose CHD, becoming clear that the efficacy of prenatal diagnosis increases as pregnancy advances, and has impacted on the management strategy for many of these lesions.
Abstract: Congenital heart defects (CHD) affect about 3–8 live births and are a leading cause of childhood mortality. The definition of CHD during fetal life, where the examiner must deal with a patient who cannot be visualized directly and is within another individual, presents unique challenges. Over the past 20 years fetal echocardiography has emerged as an accurate tool to diagnose CHD, becoming clear that the efficacy of prenatal diagnosis increases as pregnancy advances, and has impacted on the management strategy for many of these lesions. At the same time, there has been a growing social demand in developed countries for an earlier and better prenatal diagnosis, supported by the possibility of choice of whether to continue or not with the pregnancy when the fetus is affected by a congenital anomaly. These different points of view in the management of CHD often collide generating conflicting situations that the specialists involved must face. The main features relating to the prenatal approach to CHD includi...
TL;DR: The objective was to evaluate the associations between arterial, venous and intracardiac parameters and adverse perinatal outcome in growth restricted fetuses.
Abstract: The objective was to evaluate the associations between arterial, venous and intracardiac parameters and adverse perinatal outcome in growth restricted fetuses. Fetuses beyond the 26th week of gestation with an abdominal circumference below the 5th percentile were included in this prospective study. The last Doppler measurement of the umbilical artery, middle cerebral artery, ductus venosus, outflow tract waveforms, atrioventricular flow and ventricular shortening fraction before delivery and adverse perinatal outcome were used for univariate (Fisher's exact test) and multivariate (stepwise logistic regression) statistical analysis. Adverse perinatal outcome was defined as the following: umbilical artery pH < 7.1, significant neonatal morbidity, need for admission to the neonatal intensive care unit, need for intubation at birth and perinatal mortality. A total of 108 fetuses met the inclusion criteria. The univariate analysis showed that presence of arterial redistribution; the absence or reversion of the...
TL;DR: The role of cordocentesis and amniocentesis in assessment of Rhesus disease and its role in diagnosis is still unclear.
Abstract: (2004). Is there any role for cordocentesis and amniocentesis in assessment of Rhesus disease? The Ultrasound Review of Obstetrics and Gynecology: Vol. 4, No. 4, pp. 239-244.
TL;DR: Although most correctable malformations diagnosed in utero are still better managed by postnatal surgical treatment, in selected cases treatment before birth with fetal surgery may be the best option.
Abstract: Although most correctable malformations diagnosed in utero are still better managed by postnatal surgical treatment, in selected cases treatment before birth with fetal surgery may be the best option. Fetal surgery has been made possible by recent advances in fetal imaging, such as three-dimensional ultrasound and rapid acquisition magnetic resonance imaging. Recent advances in maternal anesthesia, tocolysis and technical aspects of surgery have also diminished the risks to the fetus and the mother. Successful fetal surgery treatment of lower urinary tract obstruction, congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequetration and sacrococcygeal teratoma has been carried out over the past decade. Much of the progress in open fetal surgery has been made possible by applying new surgical, anesthetic and tocolytic techniques. It has been suggested that minimally invasive fetoscopic procedures will result in less uterine irritability and preterm labor and in red...
TL;DR: This review of publications regarding the prevention of preterm labor in both asymptomatic and symptomatic patients describes the most recent publications and suggests that, for an evaluation of the cervix, all that is required is a well trained operator and a few minutes.
Abstract: During the past few years a clear relationship has been established between decreased cervical length and risk of spontaneous preterm delivery. In this review, the most recent publications are described, and results are compared with those of the present authors regarding the prevention of preterm labor in both asymptomatic and symptomatic patients. Cervical assessment with ultrasound is now widely accepted and a well standardized method which can be easily performed in both high- and low-risk patients as a screening test for preterm delivery. It is the authors' belief that, for an evaluation of the cervix, all that is required is a well trained operator and a few minutes.
TL;DR: The assessment of fetal well-being by venous Doppler velocimetry, especially in cases of intrauterine growth restriction, has been growing in importance as a consequence of better technologies in ultrasound equipment.
Abstract: The assessment of fetal well-being by venous Doppler velocimetry, especially in cases of intrauterine growth restriction, has been growing in importance as a number of researchers have been improving their studies 1 - 5 as well as a consequence of better technologies in ultrasound equipment. Since different authors have studied the fetal blood circulation with color Doppler, initially focusing their attention on the arterial system 6 - 12
TL;DR: The combined study of 2D and 3D echographic records may be useful to diagnose wound dehiscence from hysterotomy and to forecast the welfare of future gestations.
Abstract: Hysterotomy-made scars are a key factor for assessing further gestations in the same patient and so need to be monitored from the early puerperium through a whole year period following surgery. Other monitoring factors involve placenta previa, placenta acreta, ectopic cervical gestation, or uterus tearing both on parturition and at rest. Bidimensional (2D) transvaginal echography has proved a successful method in the detection of scar failures of the myometrium early in the puerperal period and afterwards, or in routine echographic exploration. Furthermore, tridimensional (3D) echography facilitates the monitoring of hysterotomy-made scars whereby total areas and depths of healed versus failing myometrium tissue can be quantified. The combined study of 2D and 3D echographic records may be useful to diagnose wound dehiscence from hysterotomy and to forecast the welfare of future gestations. In that respect, irregular cicatrization patterns can be identified from the early puerperium over the whole postpart...
TL;DR: Prenatal assessment consists of gathering and analyzing genetic, anatomical, biochemical, and physiological information about the fetus to detect any anomalies that might have repercussions during the fetal period or after birth.
Abstract: Prenatal assessment consists of gathering and analyzing genetic, anatomical, biochemical, and physiological information about the fetus to detect any anomalies that might have repercussions during the fetal period or after birth. The main purpose of prenatal diagnosis is to be able to provide families with information about foreseeable anomalies, genetic counseling, and/or therapeutic alternatives for any anomalies detected. This is a multidisciplinary task involving obstetricians, geneticists, pediatricians, radiologists, and psychologists. Prenatal diagnosis has improved considerably in recent years, thanks to technical and technological advances in chromosomal diagnosis of fetal cells, biochemistry, echography, and molecular genetics. Advances in diagnostic imaging techniques have brought about improvements in image quality and increased sensitivity and specificity, making the detection of anatomical anomalies one aspect of prenatal diagnosis that has come to play a fundamental role. Ultrasound (US) is...
TL;DR: A special case of twin reversed arterial perfusion (TRAP) sequence in a twin pregnancy with the rare finding of a functional univentricular circulation pump in the acranius, its antenatal ultrasound diagnosis and postnatal findings is reported.
Abstract: The development of twin-twin transfusion syndrome complicates 5-35% of twin pregnancies with monochorionic placentation. Acardiac twinning is the most extreme manifestation of pathological vascular anastomoses between twins. An acardiac twin is a rare complication of multifetal pregnancy, reported in the literature with an incidence of 1% in monochorionic twin pregnancies, i.e. 1/35 000 pregnancies, and more than 400 cases have been described. We review the literature on this subject and report a special case of twin reversed arterial perfusion (TRAP) sequence in a twin pregnancy with the rare finding of a functional univentricular circulation pump in the acranius, its antenatal ultrasound diagnosis and postnatal findings. Remarkably, prenatally we could demonstrate two different arterial pulsations in the umbilical cord of the acranius. Etiological hypotheses of the TRAP sequence and new implications for risk-adapted therapeutic options are discussed.
TL;DR: The Ultrasound Review of Obstetrics and Gynecology: Vol. 4, No. 4 as mentioned in this paper, pp. 252-256, is the most cited publication.
Abstract: (2004). Invasive procedures for fetal diagnosis in multiple pregnancies. The Ultrasound Review of Obstetrics and Gynecology: Vol. 4, No. 4, pp. 252-256.
TL;DR: A review of the literature suggests that MFPR reduces the risk of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies; in triplets reduced to twins, severe preterm delivery rate is lower and gestation is prolonged in comparison to average figures for triplets reported in the literature.
Abstract: The number of multiple pregnancies has dramatically increased, mainly owing to the development of assisted conception techniques. In multiple pregnancies there is an inverse relationship between the number of fetuses, and the length of gestation and infant birth weight. Multifetal pregnancy reduction (MFPR), a process by which we can reduce the number of fetuses, has been proposed as an option in order to improve pregnancy outcome. It is performed usually in the first trimester, by transabdominal injection of potassium chloride into a fetal heart, under ultrasonographic guidance. A review of the literature suggests that MFPR reduces the risk of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage seems to be associated with the final number of fetuses. In triplets reduced to twins, severe preterm delivery rate is lower and gestation is prolonged in comparison to average figures for triplets reported in the literature.
TL;DR: This is believed to be the first case report of ductus venosus dramatical changes detected in a very short time in a fetus affected by trisomy 21.
Abstract: We report a case of trisomy 21 in a fetus presenting with normal nuchal translucency and acute changes in the ductus venosus within the same ultrasound examination at 15 weeks of gestation. Ultrasound scan revealed an echogenic foci in the left ventricle, bilateral mild pyelectasis and bilateral clubfoot. Karyotyping by amniocentesis led to the diagnosis of trisomy 21. We believe this to be the first case report of ductus venosus dramatical changes detected in a very short time in a fetus affected by trisomy 21.
TL;DR: The present study aimed to describe the time sequence of abnormal changes in Doppler velocimetric parameters and its relationship with fetal heart rate recorded in growth-restricted fetuses.
Abstract: The present study aimed to describe the time sequence of abnormal changes in Doppler velocimetric parameters and its relationship with fetal heart rate recorded in growth-restricted fetuses. Fifteen singleton pregnancies with an ultrasound diagnosis of fetal growth restriction (abdominal circumference < 2SD) were evaluated prospectively and longitudinally. Fetal outcome included four perinatal deaths, seven emergency Cesarean sections due to abnormal cardiotocogram (CTG) and four admissions to the neonatal intensive-care unit. We observed 'early' Doppler changes (15 to 10 days prior to delivery) in the umbilical artery (UA), middle cerebral artery (MCA) and cerebroplacental ratio. 'Late' Doppler changes included absent or reverse end-diastolic flow in the UA, high resistance in the ductus venosus (DV) and decrease of umbilical venous blood flow. These changes appeared in 10% of cases 4-7 days prior to delivery and in up to 40% of cases on the day of delivery. Although occurring less frequently, umbilic...
TL;DR: To develop one fetal cardiac volume normality curve and evaluate its behavior during a normal gestation, using a tri-dimensional ultrasound technique, using the softwares 3D view for multiplanar purpose and VOCAL for volume purpose.
Abstract: To develop one fetal cardiac volume normality curve and evaluate its behavior during a normal gestation, using a tri-dimensional ultrasound technique. Mainly the fetal cardiac diseases have as an i...
TL;DR: The hemodynamic changes in early normally developing pregnancy and the potential clinical application of transvaginal color Doppler ultrasound in this period are reviewed.
Abstract: The introduction of transvaginal ultrasound allowed assessing in-vivo and non-invasively an, until then, an non-explored territory: the early gestation. This technique revolutionized the evaluation and management of many clinical situations during this period of pregnancy. The advent of color Doppler as a further step allowed the assessment of early pregnancy hemodynamics. This article will review the hemodynamic changes in early normally developing pregnancy and the potential clinical application of transvaginal color Doppler ultrasound in this period.