Current Issue Volume 12, Number 1 , January-March 2018

PICTURE OF THE MONTH
Tumur-Ochir Ganjiguur, Mohamed AM AboEllail, Nobuhiro Mori, Toshiyuki Hata

HDliveFlow with HDlive Silhouette Mode for Diagnosis of Persistent Right Umbilical Vein and Single Umbilical Artery

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:1-3]



We present our first experience using HDliveFlow with the HDlive silhouette mode for the diagnosis of a persistent right umbilical vein (PRUV) and single umbilical artery (SUA) in a fetus at 28 weeks and 5 days of gestation. Two-dimensional color Doppler showed a single left umbilical artery around the bladder, and PRUV originating from the umbilical cord. HDliveFlow with the HDlive silhouette mode clearly demonstrated SUA and PRUV, and the spatial connection of PRUV to the inferior vena cava through the ductus venosus was detected. The course of the fetal intra-abdominal vasculatures was clarified in detail. Moreover, visualization of the anatomical landmarks, such as the spine was possible using the HDlive silhouette mode. This technique might be a beneficial adjunctive tool for diagnosing fetal peripheral vascular anomalies with advantages over the use of conventional color Doppler alone.

Keywords: Fetus, HDliveFlow, HDliveFlow silhouette mode, Persistent right umbilical vein, Single umbilical artery.

How to cite this article: Ganjiguur TO, AboEllail MAM, Mori N, Hata T. HDliveFlow with HDlive Silhouette Mode for Diagnosis of Persistent Right Umbilical Vein and Single Umbilical Artery. Donald School J Ultrasound Obstet Gynecol 2018;12(1):1-3.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Abdel KM El Hemaly, Laila AES Mousa, Asim Kurjak, Ibrahim M Kandil, Abdel AA Aldarwish, Muhammad R Morad, Mervat M Ibrhaim, Mahmoud Eledaisy, Khaled Shehata, Mona M Ragab

Outlet Control, Pathogenesis, and Treatment: The Role of Ultrasound in Its Management.

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:4-12]



Introduction: Outlet control means continence, which is how to control body excreta (urine, flatus, and feces), control of temperance, body reaction, and control of sexual behavior and premature ejaculation. It is a nerve-muscle action, controlled by the central nervous system (CNS). Outlet control is an acquired behavior gained by learning and training to control the sympathetic nervous system. Although the sympathetic nervous system is part of the involuntary autonomic nervous system control, its function may be controlled. Evidence of this is seen in the control of body excreta control after toilet training and in how domestic animals can be trained to control body excreta as well.

Micturition and urinary continence: Urinary continence depends on a closed and empty urethra created by two factors: one is the presence of a strong intact internal urethral sphincter (IUS), which is a collagen-muscle tissue cylinder that extends from the bladder neck down to the perineal membrane. The other factor is an acquired behavior which is keeping high sympathetic tone at the IUS gained in early childhood from toilet training. Failure of either factors leads to urinary incontinence (UI).

Defecation and fecal continence: Fecal continence depends on a closed and empty anal canal created by two factors, one is inherent and one is acquired. The acquired factor is keeping high sympathetic tone at the internal anal sphincter (IAS) gained in early childhood from toilet training. The inherent factor is the presence of an intact strong IAS, which is a collagen-muscle tissue cylinder surrounding the anal canal.

Pathology: Childbirth trauma (CBT) causes laceration in the collagen chassis of the vagina leading to vaginal prolapse, and the intimately related IUS in front and/or the IAS posterior, causing UI and/or fecal incontinence (FI).

Pathophysiology: Outlet control is how to control the sympathetic nervous system and to manage different responses according to social circumstances.

Diagnosis: Structural damage is diagnosed clinically and by medical imaging: ultrasound (US), magnetic resonance imaging (MRI) and/or computed tomography (CT) scan. Structural damage will cause functional disturbance which is assessed clinically and by urodynamics.

Conclusion: Ultrasound scanning of the urethra to see if it is closed or open and the state of the IUS and visualizing the lacerations are easy and cheap methods of assessment of UI. Also US assessment of the anal canal, open or closed, and the IAS, and the extent of its laceration will help very much in its diagnosis and management.

Keywords: 3DUS, Collagen chassis, Micturition and urinary continence, Outlet control, Urinary incontinence.

How to cite this article: El Hemaly AKM, Mousa LAES, Kurjak A, Kandil IM, Aldarwish AAA, Morad MR, Ibrhaim MM, Eledaisy M, Shehata K, Ragab MM. Outlet Control, Pathogenesis, and Treatment: The Role of Ultrasound in Its Management. Donald School J Ultrasound Obstet Gynecol 2018;12(1):4-12.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Natalia V Kosovtsova, Nadezhda V Bashmakova, Mariia V Pavlichenko, Tatiana V Markova, Natalia P Shabunina-Basok, Kira A Izmestieva

Development of the Stent for Nephroamniotic Shunting

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:13-16]



Early prenatal diagnosis and timely prenatal and postnatal surgery prevent complications and unfavorable outcomes of the urinary system disorders in newborns in most cases.
One option for the correction of obstructive uropathy is stenting fetal urinary tract. Shunting the bladder is used abroad; we have experience of nephroamniotic shunting of fetal kidneys. This fetal surgery is carried out in order to preserve renal parenchyma with obstructive uropathy.

Keywords: Congenital malformations of the fetus, Minimally invasive surgery, Morphological methods, Obstructive uropathy, Pregnancy, Renal stenting, Stent.

How to cite this article: Kosovtsova NV, Bashmakova NV, Pavliñhenko MV, Markova TV, Shabunina-Basok NP, Izmestieva KA. Development of the Stent for Nephroamniotic Shunting. Donald School J Ultrasound Obstet Gynecol 2018;12(1):13-16.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Octavian Rotaru, Radu Vladareanu, Anca Burnei, Carmen Cristea, Simona Vladareanu

Clinical Experience with Kurjak Antenatal Neurodevelopmental Test in Low- and High-risk Pregnancies

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:17-22]



Introduction: To assess whether there is a difference in the behavior of fetuses from high-risk pregnancies compared with fetuses from low-risk pregnancies.

Materials and methods: We applied the Kurjak antenatal neurodevelopmental test (KANET) in high-risk (n = 65) and lowrisk (n = 119) pregnancies and compared the results. High-risk pregnancies included women with threatened preterm delivery (with premature rupture of membranes and without premature rupture of membranes), hypertension, diabetes, intrauterine growth restriction, and Rh isoimmunization.

Results: There was a difference between the results of KANET applied in these two groups; most of borderline and abnormal results were found in high-risk group, especially from pregnancies complicated by threatened preterm labor. The subgroup of pregnant women with premature rupture of membranes had most of the modified KANET scores.

Conclusion: The median values of the movements of fetuses in low-risk pregnancies were different from those in pregnancies threatened by premature birth and from the rest of the high-risk pregnancies. Fetuses from high-risk pregnancies, including threat of premature birth, had a less active fetal behavior than those from low-risk group.

Keywords: Fetal behavior, High-risk pregnancies, Kurjak antenatal neurodevelopmental test.

How to cite this article: Rotaru O, Vladareanu R, Burnei A, Cristea C, Vladareanu S. Clinical Experience with Kurjak Antenatal Neurodevelopmental Test in Low- and High-risk Pregnancies. Donald School J Ultrasound Obstet Gynecol 2018;12(1):17-22.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Aida Salihagić Kadić, Filip Glavač, Oliver Vasilj

Advances in Understanding of Neurophysiological Function of the Fetus

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:23-31]



The fascinating journey of the human life begins with two cells merging and continuing to grow into a perfectly designed apparatus comprised of multiple systems working together. Even before one draws his first breath, our nervous system plays the key role of creating a synergy in every single action and process. It all begins during fetal development, which can nowadays be observed and studied through modern imaging technologies, such as ultrasound. This gives the reader an insight on how every part of the nervous system develops and correlates with the developing body using a minimally invasive approach. This article gives an assessment of the knowledge we have regarding fetal neurophysiology and what has been learned about fetal motor and sensory development so far, as well as memory and learning, behavior and emotions and fetal cognitive functions reviewed for selected sections. Furthermore, the article provides a review of how different external factors can harm the fetus and how fetal stress presents a potential threat in fetal neurodevelopment with lasting consequences on brain structure and function. The complexity and maturation processes build up during pregnancy and continue postnatally, allowing further accommodation and development to show the astonishing capacity of brain to learn and adapt.

Keywords: Emotions, Fetal movements and action, Fetal sensory perception, Fetal stress, Four-dimensional ultrasound, Memory and learning.

How to cite this article: Salihagić Kadić A, Glavač F, Vasilj O. Advances in Understanding of Neurophysiological Function of the Fetus. Donald School J Ultrasound Obstet Gynecol 2018;12(1):23-31.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Osvaldo Padilla, Sushila Arya, Luis S Noble, Sanja Kupesic Plavsic

Saline Infusion Sonography: Tips and Tricks for Improved Visualization of the Uterine Cavity

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:32-51]



Saline infusion sonography (SIS), also known as hysterosonography or sonohysterography, is a minimally invasive ultrasound (US) technique that involves infusion of a small volume of sterile saline into the uterine cavity. It acts as a negative contrast medium that delineates hyperechogenic endometrial lining. Contrast enhanced sonographic studies provide high-resolution images of the uterine cavity enabling detection of focal and diffuse intrauterine abnormalities. In addition to visualizing intrauterine lesions, such as endometrial polyps, fibroids, and adhesions, it can assist in differentiating between different types of congenital uterine anomalies. The objective of our article is to assess the diagnostic value, indications, contraindications, and possible complications of SIS. Various clinical scenarios and typical appearances of intrauterine, endometrial, and subendometrial lesions detected by SIS are illustrated and compared with hysteroscopy images and/or macroscopically similar surgical pathology specimens. The literature on SIS is reviewed and authors discuss case-specific pitfalls and technical challenges that may lead to patient discomfort, poor image acquisition, incomplete assessment, and wrong interpretation of the images.

Keywords: Congenital uterine anomalies, Endometrial polyp, Hysterosonography, Intracavitary fibroid, Intrauterine adhesion, Saline infusion sonography, Sonohysterography, Submucosal fibroid.

How to cite this article: Padilla O, Arya S, Noble LS, Kupesic Plavsic S. Saline Infusion Sonography: Tips and Tricks for Improved Visualization of the Uterine Cavity. Donald School J Ultrasound Obstet Gynecol 2018;12(1):32-51.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Giovanni Monni, Ambra Iuculano, Cristina Peddes, Federica Murgia

Invasive Diagnostic Testing

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:52-55]



Invasive diagnostic testing used for chromosomal, Mendelian, metabolic, and congenital infective diseases is represented nowadays by three main procedures: chorionic villous sampling (CVS), amniocentesis, and fetal blood sampling (FBS). The last technique due to deoxyribonucleic acid and polymerase chain reaction (DNA-PCR) analysis is ever less employed. All these techniques imply continuous ultrasound monitoring of the needle insertion in the uterus. Nondirective genetic counseling possibly before pregnancy is mandatory to explain the indications, the procedure itself, the fetal risks, the possibility for misdiagnosis and the time for receiving the results.

Although today the risks of fetal loss after CVS and amniocentesis are very low and almost equal (1:500 and 1:800), the introduction in clinical practice of the first-trimester screening by the combined test using the measurement of the fetal nuchal translucency (NT) plus hormone dosages of pregnancy-associated plasma protein (PAPP)-A and free-beta human chorionic gonadotropin (hCG) and the aid of several other soft markers, such as nasal bone, ductus venosus, and tricuspid regurgitation and above all, the recent introduction of noninvasive prenatal screening (NIPS), with analyzing cell-free DNA in the maternal blood have led to a considerable decrease of invasive diagnostic testing. This trend concerns mostly amniocentesis, whereas the importance of CVS is largely increasing, especially if in combination with comparative genomic hybridization array. The increase in CVS procedures implies a more intense request for tutoring of young fellows in the fetal medicine centers specialized in performing it. The CVS is also the procedure chosen for Mendelian and metabolic pathologies, while amniocentesis, being performed in a later period of pregnancy, is mostly employed for congenital infective diseases. In order to avoid termination of pregnancy of pathologic fetuses, the couple can opt for preimplantation genetic diagnosis (PGD), which analyzes a single or more cells of the blastomere or the blastocyst in order to transfer in utero only the healthy embryos.

Keywords: Amniocentesis, Combined screening, Fetal blood sampling, Noninvasive prenatal screening, Preimplantation genetic diagnosis, Transabdominal chorionic villous sampling, Ultrasound.

How to cite this article: Monni G, Iuculano A, Peddes C, Murgia F. Invasive Diagnostic Testing. Donald School J Ultrasound Obstet Gynecol 2018;12(1):52-55.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Toshiyuki Hata

Fetal Face as Predictor of Fetal Brain

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:56-59]



We present recent topics regarding four-dimensional (4D) ultrasound assessment of fetal facial expressions to predict the development of the fetal brain. In several recent studies, the frequencies of seven facial expressions (mouthing, sucking, yawning, blinking, tongue expulsion, scowling/grimace, and smiling) were evaluated using 4D ultrasound. Fetal mouthing, sucking, yawning, blinking, tongue expulsion, scowling/grimace, and smiling may relate to feeding, feeding and purposeful behavior, sleep and arousal, wakefulness, feeding and speech functions, awareness, and emotion after birth respectively. Studies of the fetal face using 4D ultrasound will help elucidate the functioning of the fetal brain and the central nervous system (CNS), and help shed light on unknown areas of human biology.

Keywords: Facial expression, Fetal behavior, Fetal brain, Fetal face, Fetal movement, Four-dimensional ultrasound.

How to cite this article: Hata T. Fetal Face as Predictor of Fetal Brain. Donald School J Ultrasound Obstet Gynecol 2018;12(1):56-59.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Ana Bianchi

Fetal Arrhythmia

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:60-62]



The normal cardiac frequency of the fetus is between 120 and 160 bpm. Fetal arrhythmia happens in 1 to 2% of pregnancies. Most of them are beginning with spontaneous solution. Less than 10% implies a real problem, such as fetal hydrops and fetal death. The evaluation of the cardiac rhythm is usually done by two methods: M mode and Doppler. Each method has its advantages and limitations. It is important for the physician to be aware of the etiology, development, and natural history of these arrhythmias, and the diagnostic and therapeutic options available. A simultaneous record of both ventricular and atrial contractions with a four-chamber view is useful for assessing the relation of atrioventricular (AV) connection in fetuses with arrhythmias. We will present different types of arrhythmias: tachycardia, bradycardia, irregular rhythm, paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AFL). Fetal bradycardia is mainly due to AV block. Half of all cases are caused by associated congenital heart disease (CHD), or by maternal SS-A antibodies. Efficacy of prenatal treatment for fetal AV block is limited. Most fetuses with both PSVT and atrial flutter are successfully treated by transplacental administration of antiarrhythmic drugs. Digoxin is widely accepted as a first-line antiarrhythmic drug. Sotalol, flecainide, and amiodarone are used as second-line drugs.

Keywords: Arrhythmia, Atrial fibrillation, Paroxysmal supraventricular tachycardia.

How to cite this article: Bianchi A. Fetal Arrhythmia. Donald School J Ultrasound Obstet Gynecol 2018;12(1):60-62.

Source of support: Nil

Conflict of interest: None


ABSTRACTS

1st European Congress of Ian Donald Schools, 16-18 June 2017, Cagliari, Italy

[Year:2018] [Month:January-March] [Volumn:12 ] [Number:1] [Pages:83] [Pages No:63-83]



Over the past three decades, great progress has been made in our ability to diagnose fetal abnormalities, predict their outcome, and to perform surgical interventions. The concept of the fetus as a patient has become a standard of care and the ethical framework for maternal fetal intervention is well developed.


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