HDlive imaging of circumvallate placenta

Color Doppler, HDlive, and HDlive Silhouette features of an umbilical cord cyst before 11 weeks of gestation: Diagnostic value

OBJECTIVE

We describe transvaginal color Doppler, HDlive, and HDlive Silhouette features of an umbilical cord cyst (UCC) before 11 weeks of gestation.

METHODS

In this cohort study, 135 transvaginal dating scans were performed at 7 to 10 + 6 weeks of gestation, and 17 UCCs were identified (12.6%). UCC was evaluated using color Doppler, HDlive, and HDlive Silhouette. The clinical characteristics, pregnancy courses, and outcomes were also investigated.

RESULTS

UCC location was on the fetal side in six cases, at the free loop in 10 cases, and on the placental side in one case. There were seven single and 10 multiple cysts. Cyst diameters ranged from 3.3 to 11.3 mm (mean, 5.6; standard deviation, ±2.1). Blood flow inside the cyst was noted in three cases (17.6%). HDlive clearly showed the spatial relationships among UCC, the umbilical cord, midgut herniation, yolk sac, and embryo. Location of UCC could be clearly identified with HDlive. HDlive Silhouette showed central cysts inside UCCs in seven cases (41.2%). HDlive Silhouette also clearly demonstrated the sac of midgut herniation in the umbilical cord in 12 cases (70.6%). All UCCs resolved before 15 weeks (mean, 11.1 weeks; standard deviation, ±1.5). All fetuses with UCCs showed good neonatal outcomes.

CONCLUSION

The incidence of UCC was high compared with that in previous reports. Color Doppler, HDlive, and HDlive Silhouette may provide information on the nature and origin of UCCs before 11 weeks of gestation. UCC before 11 weeks of gestation may be a common, transient, and benign finding.

Embryonic and fetal tiny pericardial fluid collections at less than 12 weeks of gestation

OBJECTIVES

To describe embryonic and fetal tiny pericardial fluid collections (PFCs) using transvaginal sonography and HDlive Silhouette at less than 12 weeks of gestation.

METHODS

During an 8-month period from November 2021 to June 2022, one-hundred and thirty transvaginal scans were performed for first-trimester dating, and eleven tiny PFCs of the embryo or fetus were identified at 8+4 - 11+3 weeks of gestation (three at 8, six at 9, and two at 11 weeks). HDlive Silhouette features of PFC were evaluated. Their clinical characteristics and outcomes were also investigated.

RESULTS

The incidence of tiny PFCs was 8.5 % at less than 12 weeks of gestation. The mean gestational age at the initial examination was 9.5 weeks (SD: ± 0.9). The mean crown-rump length was 25.0 mm (SD: ± 8.5). The mean PFC dimension was 0.8 mm (range: 0.5-1.3, SD: ± 0.2). Pleural effusion was associated with 3 out of 11 PFCs (27.2 %). Ascites was noted in 2 cases (18.2 %). Skin edema was identified in only in 1 case (0.09 %). There was no arrhythmia. Tiny PFC could also be depicted using HDlive Silhouette. First-trimester fetal ultrasound scans at 11 - 13+6 weeks showed no abnormal findings. PFCs resolved until 13 weeks of gestation (Mean: 12 weeks, SD: ± 1.2). All PFC pregnancies resulted in healthy neonates.

CONCLUSIONS

The incidence of tiny PFCs was relatively high in early pregnancy. HDlive Silhouette can depict tiny PFCs of the embryo. Tiny PFCs in early gestation are transient, benign findings in utero.

Feto-placental Unit: From Development to Function

The placenta is an intriguing organ that allows us to survive intrauterine life. This essential organ connects both mother and fetus and plays a crucial role in maternal and fetal well-being. This chapter presents an overview of the morphological and functional aspects of human placental development. First, we describe early human placental development and the characterization of the cell types found in the human placenta. Second, the human placenta from the second trimester to the term of gestation is reviewed, focusing on the morphology and specific pathologies that affect the placenta. Finally, we focus on the placenta's primary functions, such as oxygen and nutrient transport, and their importance for placental development.

Pregnant woman with circumvallate placenta and suspected fetal hypotrophy caused by placental insufficiency: a case report

Background: The circumvallate placenta is a rare pathology of the human placenta that occurs in 1–2% of pregnancies. It is characterized by extrachorial placental development, resulting in a ring formation along the edges of the placenta, which leads to efficiency impairment. As a consequence, it causes an intrauterine fetal hypotrophy. The fetal hypotrophic pregnancies are classified as high-risk pregnancies, requiring not only intensive monitoring of fetal development but also maternal and fetal care by the highest reference clinical center. Aim of the study: The aim of this study was to analyze the case of a patient with circumvallate placenta and fetal hypotrophy suspicion. Material and methods: The study was based on the case study method. The data was obtained by analyzing medical documentation collected during hospitalization. The patient was interviewed and observed. All of the selected parameters were measured and scaled. Case study: A 30-year-old primiparous woman at 38+1 weeks gestation, with diagnosed circumvallate placenta and suspected fetal hypotrophy. The pregnancy had several complications, including gestational hypothyroidism. There was spotting and imminent abortion in the first trimester and in the second and third trimester, the patient was treated for vaginal mycosis. There was a risk of preterm labor in the third trimester. The patient was admitted to the delivery room in the first stage of labor. The course of first stage of labor was normal however the second stage of labor was complicated. Obstructed labor with ace presentation, mentoposterior position. A lower uterine segment cesarean section (LUSCS) was performed and a live full-term female infant was delivered, which was found to be small for gestational age (SGA). The course of the early puerperium was uncomplicated with an expected duration of stay in the neonatology department. Both mother and baby were discharged from hospital on postpartum day 3. Conclusions: Circumvallate placenta is not a contraindication to natural delivery however is associated with an increased risk of many perinatal complications. Holistic care during delivery and the early puerperium requires specialized knowledge and skills of medical staff in taking care of both of the mother and the child.

Circumvallate placenta and abnormal cord insertion as risk factors for intrauterine growth restriction and preterm birth: a case report

Objectives

Circumvallate placenta is a rare abnormality of placental shape. Current data indicates that a circumvallate placenta can be a risk factor for severe adverse obstetric and neonatal outcomes such as antepartum bleeding, premature delivery, oligohydramnios, intrauterine growth restriction and placental abruption. An unusual insertion of the umbilical cord can cause a reduction of perfusion and can also lead to pregnancy complications. However, the clinical significance of these pathoanatomical findings often remains unclear.

Case presentation

We report a case of a 22-year-old third gravida nullipara in 28+2 pregnancy weeks with a pathological cardiotocography (CTG) and a growth restricted fetus with oligohydramnios and pathological umbilical blood flow. Due to recurrent decelerations of fetal heart rate the baby was delivered via cesarean section. The examination of the placenta showed a circumvallate placenta and fixated umbilical cord mimicking a battledore insertion.

Conclusions

It can be concluded that circumvallate placenta may predispose to severe obstetric complications. Women with circumvallate placenta and abnormal cord insertion probably benefit from stringent follow ups in a specialized perinatal center. Histopathological examination of the placenta can be a diagnostic tool in women with recurrent obstetric complications.

Intrauterine Linear Echogenicities in the Gravid Uterus: What Radiologists Should Know

Intrauterine linear echogenicity (ILE) is a common ultrasonographic finding in the gravid uterus and has variable causes and variable maternal and fetal outcomes. Correctly categorizing ILE during pregnancy is crucial for guiding surveillance and advanced imaging strategies. Common causes of ILE include membranes in multiple gestations, uterine synechiae with amniotic sheets, and uterine duplication anomalies. Less common causes include circumvallate placenta, chorioamniotic separation, and hemorrhage between membranes. Amniotic band syndrome is a rare but important diagnosis to consider, as it causes severe fetal defects. Imaging findings enable body stalk anomaly, a lethal defect, to be distinguished from amniotic bands, which although destructive are not necessarily lethal. This review describes the key imaging findings used to differentiate the various types of ILE in pregnancy, thus enabling accurate diagnosis and appropriate patient counseling. Online supplemental material is available for this article. ^©RSNA, 2018.

HDlive Silhouette Mode With Spatiotemporal Image Correlation for Assessment of the Fetal Heart

OBJECTIVES

The purpose of this article is to present our experience with normal and abnormal fetal cardiac structures reconstructed in the HDlive silhouette mode (GE Healthcare Japan, Tokyo, Japan) with spatiotemporal image correlation (STIC).

METHODS

Twenty-two fetuses with normal hearts and 1 fetus with a congenital heart anomaly (Ebstein anomaly) at 20 to 36 weeks' gestation were studied in the HDlive silhouette mode with STIC.

RESULTS

In normal fetal hearts, 4 cardiac chambers and crisscross arrangements of the pulmonary artery and aorta were clearly identified. This modality facilitated visualization of the relationships and course of the outflow and inflow tracts, thus helping the operators more effectively understand the spatial relationships among the cardiac chambers and vessels. The opening and closing of mitral, tricuspid, pulmonary, and aortic valves were ascertained in the en face view of both atrioventricular valves and great vessels. In the fetus with Ebstein anomaly, a low attachment of the tricuspid valve and an enlarged right atrium were evident.

CONCLUSIONS

The HDlive silhouette mode with STIC provides new visual experiences for physicians, owing to the anatomically clear depiction of fetal cardiac structures, and it may be an easier way to depict the spatial relationships among fetal cardiac chambers, great arteries, and veins.

Three-dimensional ultrasonography by means of HDlive rendering in the first trimester of pregnancy: A pictorial review

Our objective was to describe early embryo/fetus anatomy and abnormalities provided by three and four-dimensional (3D/4D) ultrasound using HDlive rendering technology in the first trimester of pregnancy. Normal and pathologic embryonic and fetal volume data set with postprocessing using HDlive rendering mode. Virtual fetoscopic imaging of the normal and pathologic fetus even at early stage of development with increasing maternal-fetal bonding process. HDlive represents a novel and valuable lightening system for 3D/4D ultrasound application that may aid the prenatal interpretation of early congenital malformations although limitations and cautions are still needed for inclusion in obstetric clinical practice.

HDliveFlow in the Assessment of Fetal Circulation

With the appearance of the latest three/four-dimensional (3D/4D) ultrasound machine (HDliveFlow, Voluson E10, GE Healthcare, Zipf, Austria), HDliveFlow with glass-body rendering mode or silhouette mode will facilitate more precise assessments of the fetal heart and peripheral circulation. The resolution of 3D/4D color/power Doppler using the HDlive technique shows a significant improvement compared to conventional 3D/4D color/power Doppler and the fetal heart with great vessels, small peripheral vessels, and placental blood flow can now be clearly recognized. HDliveFlow with glass-body rendering mode or silhouette mode combines the advantages of a spatial view of the great arteries in addition to the visualization of anatomical landmarks, such as the spine or diaphragm. Its use may provide potential advantages in cases of congenital heart anomalies and placental vascularity over the use of conventional 3D/4D color/power Doppler. This novel technique may assist in the evaluation of the fetal cardiovascular system and fetoplacental vascularity, and offer potential advantages relative to conventional 2D color/power Doppler assessments. In this article, we present the latest state-of-the-art HDliveFlow with glass-body rendering mode or silhouette mode of normal and abnormal fetal hearts, placentas, and umbilical cords. We also discuss the present and future applicability of 3D/4D color/ power Doppler to assess the fetal circulation. HDliveFlow with glass-body rendering mode or silhouette mode may become an important modality in future research on fetal cardiac and placental blood flow, and assist in the prenatal diagnosis of fetal congenital heart disease and placental vascular abnormalities.

How to cite this article

Hata T, AboEllail MAM, Sajapala S, Ito M. HDliveFlow in the Assessment of Fetal Circulation. Donald School J Ultrasound Obstet Gynecol 2015;9(4):462-470.