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Le Lous M, Vasconcelos F, Di Vece C, Dromey B, Napolitano R, Yoo S, Edwards E, Huaulme A, Peebles D, Stoyanov D, Jannin P. Probe motion during mid-trimester fetal anomaly scan in the clinical setting: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2024; 298:13-17. [PMID: 38705008 DOI: 10.1016/j.ejogrb.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION This study aims to investigate probe motion during full mid-trimester anomaly scans. METHODS We undertook a prospective, observational study of obstetric sonographers at a UK University Teaching Hospital. We collected prospectively full-length video recordings of routine second-trimester anomaly scans synchronized with probe trajectory tracking data during the scan. Videos were reviewed and trajectories analyzed using duration, path metrics (path length, velocity, acceleration, jerk, and volume) and angular metrics (spectral arc, angular area, angular velocity, angular acceleration, and angular jerk). These trajectories were then compared according to the participant level of expertise, fetal presentation, and patient BMI. RESULTS A total of 17 anomaly scans were recorded. The average velocity of the probe was 12.9 ± 3.4 mm/s for the consultants versus 24.6 ± 5.7 mm/s for the fellows (p = 0.02), the average acceleration 170.4 ± 26.3 mm/s2 versus 328.9 ± 62.7 mm/s2 (p = 0.02), and the average jerk 7491.7 ± 1056.1 mm/s3 versus 14944.1 ± 3146.3 mm/s3 (p = 0.02), the working volume 9.106 ± 4.106 mm3 versus 29.106 ± 11.106 mm3 (p = 0.03), respectively. The angular metrics were not significantly different according to the participant level of expertise, the fetal presentation, or to patients BMI. CONCLUSION Some differences in the probe path metrics (velocity, acceleration, jerk and working volume) were noticed according to operator's level.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, INSERM, LTSI - UMR 1099, F35000 Rennes, France; CIC Inserm 1414, University Hospital of Rennes, University of Rennes 1, Rennes, France; Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom.
| | - Francisco Vasconcelos
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Chiara Di Vece
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Brian Dromey
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom; Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Soojoeong Yoo
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Eddie Edwards
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Arnaud Huaulme
- Univ Rennes, INSERM, LTSI - UMR 1099, F35000 Rennes, France
| | - Donald Peebles
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom; Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Danail Stoyanov
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Pierre Jannin
- Univ Rennes, INSERM, LTSI - UMR 1099, F35000 Rennes, France
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Elron E, Maya I, Shefer-Averbuch N, Kahana S, Matar R, Klein K, Agmon-Fishman I, Gurevitch M, Basel-Salmon L, Levy M. The Diagnostic Yield of Chromosomal Microarray Analysis in Third-Trimester Fetal Abnormalities. Am J Perinatol 2024. [PMID: 38688298 DOI: 10.1055/s-0044-1786514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This study aimed to determine the diagnostic yield of chromosomal microarray analysis (CMA) performed in cases of fetal abnormalities detected during the third trimester of pregnancy. STUDY DESIGN A retrospective review of medical records was conducted for women who underwent amniocentesis at or beyond 28 weeks of gestation between January 2017 and February 2023. CMA results of pregnancies with abnormal sonographic findings not detected before 28 weeks were included. RESULTS A total of 482 fetuses met the inclusion criteria. The average maternal age was 31.3 years, and the average gestational age at amniocentesis was 32.3 weeks. The overall diagnostic yield of CMA was 6.2% (30 clinically significant copy number variations [CNVs]). The yield was 16.4% in cases with two or more fetal malformations, while cases with a single anomaly revealed a diagnostic yield of 7.3%. Cases presenting isolated polyhydramnios or isolated fetal growth restriction had a lower yield of 9.3 and 5.4%, respectively. Of the 30 clinically significant cases, 19 (or 63.4%) exhibited recurrent CNVs. The remaining 11 cases (or 36.6%) presented unique CNVs. The theoretical yield of Noninvasive Prenatal Testing (NIPT) in our cohort is 2% for aneuploidy, which implies that it could potentially miss up to 70% of the significant findings that could be identified by CMA. In 80% of the fetuses (or 24 out of 30) with clinically significant CNVs, the structural abnormalities detected on fetal ultrasound examinations corresponded with the CMA results. CONCLUSION The 6.2% detection rate of significant CNVs in late-onset fetal anomalies confirms the value of CMA in third-trimester amniocentesis. The findings underscore the necessity of CMA for detecting CNVs potentially overlooked by NIPT and emphasize the importance of thorough genetic counseling. KEY POINTS · CMA yields 6.2% for third-trimester anomalies.. · NIPT may miss 70% of CMA findings.. · Ultrasound matched 80% of CMA results..
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Affiliation(s)
- Eyal Elron
- Department of Neonatology, Schneider Children's Medical Center, Petah Tikva, Israel
- Pediatric Genetics Unit, Schneider Children's Medical Center, Petah Tikva, Israel
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Maya
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Shefer-Averbuch
- Pediatric Genetics Unit, Schneider Children's Medical Center, Petah Tikva, Israel
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, The Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Sarit Kahana
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Reut Matar
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Kochav Klein
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Ifat Agmon-Fishman
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Merav Gurevitch
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Lina Basel-Salmon
- Pediatric Genetics Unit, Schneider Children's Medical Center, Petah Tikva, Israel
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Michal Levy
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Albakri AA, Alzahrani MM, Alghamdi SH. Medical Imaging in Pregnancy: Safety, Appropriate Utilization, and Alternative Modalities for Imaging Pregnant Patients. Cureus 2024; 16:e54346. [PMID: 38500900 PMCID: PMC10945608 DOI: 10.7759/cureus.54346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/20/2024] Open
Abstract
This article reviews the existing literature on diagnostic and medical imaging of pregnant women, the risks and safety measures of different medical imaging modalities, and alternative modalities for imaging pregnant patients. Different medical imaging modalities such as MRI, CT scan, ultrasound, nuclear medicine, and X-ray imaging help to evaluate women with recognized or unrecognized pregnancies and identify any underlying complications among pregnant patients. Fetuses are more sensitive to radiation and the effects of medical imaging as compared to adults since they have a rapidly developing cell system. During cell proliferation, migration, and differentiation, fetuses suffer greatly from imaging radiation since they are developing under a dynamic system. To ensure safety, pregnant women should discuss the benefits and risks of medical imaging with their physicians. In addition, radiologists should not perform any medical imaging procedure without the patient's consent, unless the patient cannot make any sound decision. Fetal risks of medical imaging include slow growth and development of the fetus, abortion, malformations, impaired brain function, abnormal childhood growth, and neurological development. Diagnostic imaging procedures are necessary when a condition that needs medical evaluation arises during pregnancy such as appendicitis.
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Affiliation(s)
| | | | - Saeed H Alghamdi
- Interventional Radiology, King Fahad General Hospital, Al Baha, SAU
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Nerune SM, Bidri SR, Sandilya U, Das SK. Role of autopsy in diagnosing asplenia and right bilobed lung in a fetus with dextrocardia. BMJ Case Rep 2023; 16:e256209. [PMID: 37775274 PMCID: PMC10546108 DOI: 10.1136/bcr-2023-256209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
We present a unique case of a fetus with dextrocardia, asplenia and a right bilobed lung in a primigravida woman in her 20s at 21 weeks' gestation. Prenatal ultrasound examination revealed dextrocardia and other anomalies such as atrioventricular septal defect and situs ambiguous with the gallbladder on the left, leading to termination of the pregnancy. Fetal autopsy confirmed the diagnosis, detected additional findings such as asplenia and right bilobed lung missed on ultrasound and highlighted the importance of autopsy in prenatal diagnosis. This rare case emphasises the value of a comprehensive prenatal assessment, fetal autopsy and a multidisciplinary approach in diagnosing, managing and counselling families affected by congenital anomalies. Timely detection and appropriate genetic counselling can guide affected families in making informed decisions regarding future pregnancies while providing closure and support in their grieving process.
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Affiliation(s)
- Savitri M Nerune
- Department of Pathology, Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karantaka, India
| | - Shailaja R Bidri
- Department of Obstetrics and Gynecology, Shri B.M. Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India
| | - Upasana Sandilya
- Department of Pathology, Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karantaka, India
| | - Sayandeep K Das
- Department of Pathology, Shri B.M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karantaka, India
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Yılmazer Yonder E, Cagan M, Deren O, Gucer KS. Comparison of Prenatal Ultrasound and Autopsy Findings of Fetuses Terminated in Second Trimester: A Five-Year Experience of a Tertiary Center. Fetal Pediatr Pathol 2023; 42:410-422. [PMID: 36591910 DOI: 10.1080/15513815.2022.2161860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: The aim of this study is to compare the prenatal ultrasonography (US) and the autopsy findings of the fetuses of 12-24th gestational weeks. Methods: This retrospective study comprises 84 fetuses autopsied. The correlation between US and autopsy findings was classified into four categories: (A) Compatible, (B) Minor findings added, (C) Major findings added, and (D) Incompatible. Results: Malformations were the most common medical termination indication. The most frequent findings at autopsy were multiple system findings followed by central nervous system. Prenatal US and autopsy findings were completely compatible in 48 fetuses (57.1%), while additional minor and major autopsy findings were found in 26 (31.0%) and 4 (4.8%), respectively. Autopsy and US findings were incompatible in 6 fetuses (7.1%). Conclusion: Prenatal ultrasound and fetal autopsy are complementary tools to obtain detailed and complete diagnosis of fetal anomalies and fetal autopsy is still a valuable tool to obtain further diagnostic information.
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Affiliation(s)
- Ezgi Yılmazer Yonder
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozgur Deren
- Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kadri Safak Gucer
- Division of Pediatric Pathology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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Ali NI, Zain H, Choudhary RK, Satti HA. The efficiency of using maternal markers in early detection and management of congenital anomalies in Majmaah city, KSA. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tan AG, Sethi N, Sulaiman S. Evaluation of prenatal central nervous system anomalies: obstetric management, fetal outcomes and chromosome abnormalities. BMC Pregnancy Childbirth 2022; 22:210. [PMID: 35291955 PMCID: PMC8925063 DOI: 10.1186/s12884-022-04555-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To study the outcomes of fetuses who were diagnosed with central nervous system (CNS) anomalies during prenatal period and to describe the obstetric management of those pregnancies. Methods In this retrospective study, fetuses who were detected to have central nervous system anomalies by prenatal ultrasound from January 2010 to December 2019 were recruited. Data regarding prenatal diagnosis and obstetric outcomes were retrieved from maternal and paediatric records. The prognosis of fetuses who were born alive was classified based on their neurodevelopmental outcome within two years of life. Results There were a total of 365 fetuses with CNS anomalies within the 10-year study period, with a mean gestational age of 24.65±7.37 weeks at diagnosis. Ventriculomegaly (23.36%) was the commonest CNS anomalies seen. 198 (54.20%) of these fetuses had associated extra-CNS anomalies, with cardiovascular being the most common system involved. Fetal karyotyping was performed in 111 pregnancies, with chromosomal aberrations detected in 53 (49.07%) cases and culture failure in 3 cases. Majority of the chromosomal abnormalities were Edward syndrome (trisomy 18) and Patau syndrome (trisomy 13). Fetuses with congenital CNS anomalies and abnormal chromosomal karyotyping were more likely to be diagnosed earlier by prenatal ultrasound and tend to have poorer obstetric and neurocognitive prognosis. Prenatally, 86 (23.56%) of the cases were lost to follow up and likely to deliver elsewhere. Among the 279 cases whom their pregnancy outcomes were available, 139 (49.82%) pregnancies resulted in live births, 105 (37.63%) pregnancies were electively terminated, while the remaining 35 (12.54%) pregnancies ended in spontaneous loss. The decision of termination of pregnancy largely depends on mean diagnostic gestational age, presence of chromosomal aberrations and abnormal amniotic fluid volume in those fetuses. Two years after delivery, only 75 (53.96%) children out of 139 live births were still alive, 43 (30.93%) died and 21 (15.11%) cases were lost to follow-up. 32 (23.02%) children with prenatally diagnosed CNS anomalies had normal neurodevelopmental outcome. The presence of multiple CNS anomalies and involvement of extra-CNS anomalies indicated a poorer neurodevelopmental prognosis. Conclusion Less than 50% of fetuses with prenatally diagnosed CNS anomalies resulted in live births. Even if they survive till delivery, 36.45% of them passed away within 2 years and 62.79% of children who survived till 2 years old had neurodevelopmental disability.
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Affiliation(s)
- Ann Gee Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Neha Sethi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Chen X, Jiang Y, Chen R, Qi Q, Zhang X, Zhao S, Liu C, Wang W, Li Y, Sun G, Song J, Huang H, Cheng C, Zhang J, Cheng L, Liu J. Clinical efficiency of simultaneous CNV-seq and whole-exome sequencing for testing fetal structural anomalies. J Transl Med 2022; 20:10. [PMID: 34980134 PMCID: PMC8722033 DOI: 10.1186/s12967-021-03202-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022] Open
Abstract
Background Birth defects are responsible for approximately 7% of neonatal deaths worldwide by World Health Organization in 2004. Many methods have been utilized for examining the congenital anomalies in fetuses. This study aims to investigate the efficiency of simultaneous CNV-seq and whole-exome sequencing (WES) in the diagnosis of fetal anomaly based on a large Chinese cohort. Methods In this cohort study, 1800 pregnant women with singleton fetus in Hubei Province were recruited from 2018 to 2020 for prenatal ultrasonic screening. Those with fetal structural anomalies were transferred to the Maternal and Child Health Hospital of Hubei Province through a referral network in Hubei, China. After multidisciplinary consultation and decision on fetal outcome, products of conception (POC) samples were obtained. Simultaneous CNV-seq and WES was conducted to identify the fetal anomalies that can compress initial DNA and turnaround time of reports. Results In total, 959 couples were finally eligible for the enrollment. A total of 227 trios were identified with a causative alteration (CNV or variant), among which 191 (84.14%) were de novo. Double diagnosis of pathogenic CNVs and variants have been identified in 10 fetuses. The diagnostic yield of multisystem anomalies was significantly higher than single system anomalies (32.28% vs. 22.36%, P = 0.0183). The diagnostic rate of fetuses with consistent intra- and extra-uterine phenotypes (172/684) was significantly higher than the rate of these with inconsistent phenotypes (17/116, P = 0.0130). Conclusions Simultaneous CNV-seq and WES analysis contributed to fetal anomaly diagnosis and played a vital role in elucidating complex anomalies with compound causes. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-03202-9.
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Affiliation(s)
- Xinlin Chen
- Department of Ultrasound Diagnosis, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Yulin Jiang
- Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ruiguo Chen
- Berry Genomics Corporation, Beijing, 102200, China
| | - Qingwei Qi
- Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | | | - Sheng Zhao
- Department of Ultrasound Diagnosis, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Chaoshi Liu
- Berry Genomics Corporation, Beijing, 102200, China
| | - Weiyun Wang
- Department of Ultrasound Diagnosis, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Yuezhen Li
- Berry Genomics Corporation, Beijing, 102200, China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Jieping Song
- Department of Genetic Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Hui Huang
- Department of Ultrasound Diagnosis, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | - Chen Cheng
- Department of Ultrasound Diagnosis, Maternal and Child Health Hospital of Hubei Province, Wuhan, 430070, Hubei, China
| | | | - Longxian Cheng
- Department of Ultrasound Diagnosis, Hubei Maternity and Child Health Hospital, No. 745, Wuluo Road, Hongshan District, Wuhan, 430030, Hubei, China.
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1, Shuaifu Garden, Dongcheng District, Beijing, 100730, China.
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Elsamadicy E, Kundishora A, Turan S. Worm Sign: A possible first-trimester sonographic marker for intracranial haemorrhage resulting in significant cortical disruption. Australas J Ultrasound Med 2021; 24:112-116. [PMID: 34765420 DOI: 10.1002/ajum.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fetal intracranial haemorrhage (ICH) is a pathophysiological process involving haemorrhagic and hypoxic-ischaemic insults resulting in antenatal brain damage. Insults to the central nervous system are usually not detected until the second or third trimester. In this case presentation, we present a possible prenatal ultrasound marker, 'worm sign', representing cortical disruption secondary to suspected ICH at 13 weeks' gestation. According to current literature review, this is one of the first cases of ICH, diagnosed in the first-trimester and highlights the importance of early neurovascular and structural evaluation of the fetal brain at the time of first-trimester ultrasound screening.
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Affiliation(s)
- Emad Elsamadicy
- Department of Obstetrics, Gynecology & Reproductive Sciences University of Maryland School of Medicine Baltimore MA USA
| | - Adam Kundishora
- Department of Neurosurgery Yale University School of Medicine New Haven CT USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences University of Maryland School of Medicine Baltimore MA USA
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Leiroz R, Aquino MDA, Santos KP, Monteiro MDC, Aires TSDF, Araujo Júnior E, Sarno M. Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in Northeastern Brazil. J Gynecol Obstet Hum Reprod 2021; 50:102225. [PMID: 34508915 DOI: 10.1016/j.jogoh.2021.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the performance of a basic mid-trimester fetal ultrasound scan protocol for the diagnosis of congenital anomalies by calculating its accuracy, sensitivity, and specificity. METHODS This longitudinal cohort study involved singleton pregnant women recruited at the mid-trimester fetal ultrasound scan through the postnatal evaluation of congenital anomalies. Pregnant women who underwent a routine mid-trimester ultrasound scan for fetal abnormalities at 20-24 weeks of gestation were enrolled in this study. After childbirth, we searched their medical records on gestational outcomes and neonatal examination records, as well as complementary medical examinations, to assess the ultrasound performance in diagnosing congenital malformations. RESULTS We included 967 pregnant women in the study population, and prenatal ultrasound scans detected congenital abnormalities in 67 fetuses (6.9%). Among newborns, 54 (5.6%) were postnatally diagnosed with malformations. The overall sensitivity and specificity of the mid-trimester ultrasound scan for congenital malformation detection were 61.1% and 96.3%, respectively, with an accuracy of 94.3% (p < .05). CONCLUSION The mid-trimester ultrasound scan had good accuracy in the detection of congenital malformations, although the overall sensitivity does not support it as the only screening test for anomalies throughout pregnancy.
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Affiliation(s)
- Rafael Leiroz
- Department of Fetal Medicine, Caliper Imaging School, Salvador-BA, Brazil
| | - Marcelo de Amorim Aquino
- Department of Fetal Medicine, Caliper Imaging School, Salvador-BA, Brazil; Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador-BA, Brazil
| | - Kleber Pimentel Santos
- Department of Fetal Medicine, Caliper Imaging School, Salvador-BA, Brazil; Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador-BA, Brazil
| | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
| | - Manoel Sarno
- Department of Fetal Medicine, Caliper Imaging School, Salvador-BA, Brazil; Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador-BA, Brazil
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Fung ACH, Kan ASY, Chung PH, Shek NWM, Chan IHY, Wong KKY. Antenatal counselling of congenital surgical anomalies: A decade of experience in a local tertiary centre. J Paediatr Child Health 2021; 57:710-714. [PMID: 33400340 DOI: 10.1111/jpc.15321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
AIM This study reviewed the experience of a tertiary paediatric surgery and obstetric centre on prenatal counselling of congenital surgical anomalies and to explore the role of paediatric surgeons on perinatal outcomes of antenatally detected anomalies. METHODS A retrospective analysis of all antenatal consultations and subsequent medical records after birth were performed between 2009 and 2018. Data including timing of consultations, gestations at birth, birthweight, impact on obstetrics management, neonatal mortality and need of surgery were included. RESULTS A total of 256 fetuses were diagnosed to have congenital surgical anomalies on antenatal ultrasound. The most common were urogenital (31%) and thoracic (30%) anomalies. Twelve of the 256 (4.7%) had multiple anomalies. The mean gestation at referral was 23 ± 5 weeks. The majority (85.4%) were born at term. Mode and timing of delivery was altered in 7% of patients. Four received fetal intervention after surgical consultation. Termination of pregnancy rate was 5.4% (n = 14). Neonatal death was reported in 7.8% of the cohort. CONCLUSION Congenital surgical anomalies had a significant impact on perinatal outcome as well as morbidity in later infancy and childhood. A multidisciplinary approach in managing pregnancy with these anomalies should be implemented. Combined-specialty consultations and counselling deliver valuable information for parents.
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Affiliation(s)
| | - Anita Sik Yau Kan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Patrick Hy Chung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Noel Wing Man Shek
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Ivy Hau Yee Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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Chang CS, Hong SY, Kim SY, Kim YM, Sung JH, Choi SJ, Oh SY, Roh CR, Song J, Huh J, Kang IS. Prevalence of associated extracardiac anomalies in prenatally diagnosed congenital heart diseases. PLoS One 2021; 16:e0248894. [PMID: 33735284 PMCID: PMC7971844 DOI: 10.1371/journal.pone.0248894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/05/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the prevalence of extracardiac anomalies (ECA) in prenatally diagnosed congenital heart diseases (CHD), and to provide more information for counseling of women with prenatally diagnosed fetal CHD. Methods This was a retrospective cohort study of 791 cases of fetal CHD diagnosed by prenatal ultrasound from January 2005 to April 2018. Associated ECAs included extracardiac structural malformation (ECM), chromosomal anomaly, and 22q11.2 microdeletion. CHD was classified into 10 groups according to a modified anatomic and clinical classification of congenital heart defects. Results The overall prevalence of ECA in our CHD cohort was 28.6% (226/791): ECM, 25.3%; chromosomal anomaly, 11.7%; and 22q11.2 microdeletion, 5.5%. For those with ECM, ventricular septal defect (VSD) had the highest prevalence (34.5%), followed by anomalies of atrioventricular junctions and valves (28.8%) and heterotaxy (26.9%). For those with chromosomal anomaly, anomalies of atrioventricular junctions and valves had the highest prevalence (37.5%), followed by anomalies of atria and interatrial communications (25.0%) and VSD (22.9%). 22q11.2 microdeletion was detected only in those with anomalies of extrapericardial arterial trunks (14.3%) or ventricular outflow tracts (6.4%). Conclusion ECM, chromosomal anomaly, and 22q11.2 microdeletion have different prevalence according to the type of CHD.
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Affiliation(s)
- Chi-Son Chang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sir-yeon Hong
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-yeon Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-min Kim
- Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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