Andrzej Lysikiewicz

Live three-dimensional echocardiography of the human fetus.

The purpose of this study was to investigate the feasibility of using a new three‐dimensional ultrasound system to perform fetal echocardiographic examination in real time. The device consisted of a Philips Sonos 7500 (Andover, MA) ultrasound system and a 4 MHz, 4X matrix transducer. The study was approved by the Institutional Review Board and was performed with the informed consent of the mother. The study population consisted of 12 singleton fetuses with gestational ages of 16–37 weeks. Of these, ten fetuses had normal cardiac anatomy, one had complete atrioventricular septal defect, and the other a thickened tricuspid valve. The system allowed comprehensive visualization of fetal cardiac anatomy and color Doppler flow unattainable by two‐dimensional approaches. This preliminary investigation suggests that live three‐dimensional fetal echocardiography could be a significant tool for prenatal diagnosis and assessment of congenital heart disease in the human fetus. (ECHOCARDIOGRAPHY, Volume 20, November 2003)

Umbilical arterial Doppler sonography for fetal surveillance in pregnancies complicated by pregestational diabetes mellitus

Antepartum fetal surveillance constitutes an essential component of the standards of care in managing pregnancies complicated by pregestational diabetes mellitus. Fetal hyperglycemia is associated with increased oxidative metabolism, hypoxemia and increased brain and renal perfusion without any significant changes in fetoplacental perfusion. Human cordocentesis data show that fetal hypoxemia and acidemia are associated with changes in the umbilical arterial Doppler indices in maternal diabetes mellitus complicated by fetal growth restriction or pre-eclampsia. Consistent with this, observational studies suggest significant diagnostic efficacy of the Doppler method in diabetic pregnancies complicated by vasculopathy, and in the presence of fetal growth restriction or hypertension. However, the relationship between abnormal umbilical arterial Doppler indices and the quality of glycemic control remains unproved. Although there are no randomized trials specifically addressing this issue, existing evidence suggests that Doppler velocimetry of the umbilical artery may be beneficial for antepartum fetal surveillance in diabetic pregnancies complicated by vasculopathy, fetal growth restriction or hypertension.

Effects of the individual uterine contraction on fetal head descent and cervical dilatation during the active stage of labor

OBJECTIVE To evaluate the effects of individual uterine contractions on instantaneous values of cervical dilatation and head station along the active stage of labor. STUDY DESIGN Cervix dilatation and fetal head station were measured continuously using a labor monitor that is based on ultrasonic triangulation. The relations between the two variables in response to each contraction were analyzed. The relative effect of the contraction on head station and on cervical dilatation was demonstrated by plotting one against the other during the contraction and quantified by two indices: (a) the contraction vector that integrates the maximum effect of uterine contraction on both variables and (b) the efficiency vector that indicates the contribution of each contraction to labor progression. The amplitude and angle of each vector were calculated. Correlation between the waveforms of head station and cervix dilatation during contractions was also calculated. These indices were plotted against cervix dilatation and head station at different stages in labor progress. RESULTS Effects of uterine contractions on cervix dilatation and head station varied during labor. The amplitude of the contraction vector and efficiency vector increased to a maximal value at cervical dilatation of 6 cm. The angle of the contraction vector increased with the progress of labor. Correlation between cervical dilatation and head station was maximal at the engagement zone of the birth canal. High variability was observed between subjects for all indices measured. CONCLUSION The contraction vector and the efficiency vector exhibited distinct behavior during labor. These vectors may serve as indicators for normal and abnormal progress of labor. More data are required to obtain statistical significance.

Doppler Velocimetry in Maternal Alloimmunization

Obstetrical management of isoimmunized pregnancy is determined by the severity of fetal anemia. Early and accurate diagnosis of anemia makes safe and effective clinical management. In fetal Rh disease, fetal anemia leads to cardiovascular changes in blood flow through the major fetal vessels, detectable by Doppler velocimetry is particularly attractive since examination can be quick, safe and cost-effective.

Doppler Sonography in Pregnancies Complicated with Pregestational Diabetes Mellitus

Antepartum fetal surveillance constitutes an essential component of the standards of care in managing pregnancies complicated with pregestational diabetes mellitus. Fetal hyperglycemia is associated with increased oxidative metabolism, hypoxemia, and increased brain and renal perfusion without any significant changes in fetoplacental perfusion. Moreover, the relationship between abnormal umbilical arterial Doppler indices and the quality of glycemic control remains unproven; however, observational studies suggest significant diagnostic efficacy of the umbilical arterial Doppler method in diabetic pregnancies complicated with FGR or hypertension. Although there are no randomized trials specifically addressing this issue, existing evidence suggests that Doppler velocimetry of the umbilical artery may be beneficial for antepartum fetal surveillance in diabetic pregnancies in the presence of these complications. Such utilization should be integrated with the existing standards of practice.

OC5.06: Three dimensional echocardiography of the fetus using 2 dimensional matrix array: the feasibility of multiplanar imaging

Background: Three dimensional (3D) echocardiography utilizing two dimensional (2D) matrix array transducer allows true real time acquisition of 3D volume data and permits its subsequent comprehensive analysis in several modes including multi-planar (MP) viewing in infinitely variable planes. Objective: To investigate the feasibility of conducting fetal cardiac evaluation using MP analysis employing a 2D matrix array ultrasound system. Method: The study population consisted of 54 singleton fetuses between 19 to 23 weeks of pregnancy referred for fetal cardiac assessment. A second generation 2D matrix array ultrasound system was used (Sonos7500 Philips, Andover, MA). Following the standard 2D echocardiographic examination, real time 3D echocardiography was performed using a 4 MHz, X4 transducer. Full volume 3D data-stream of the fetal heart was acquired using a simulated heart rate gating and stored for subsequent analysis which was performed offline using proprietary software (QLab version 4, Philips). Procedures for systematic offline image analysis of the previously recorded 3D data stream in multiple variable planes were developed to enable optimal viewing of the fetal cardiac anatomy. Results: Offline MP analysis of full volume 3D data stream allowed dynamic imaging of the fetal cardiac anatomy in all cases. Comprehensive assessment of the ventricular and atrial chambers, outflow tracts and their cross over relationship, and ventricular and atrial septa could be performed in 94.4% (51/54) of cases. As in 2D echocardiography, spine anterior fetal position and extreme maternal habitus contributed to suboptimal imaging in 3 cases. Conclusions: Multiplanar dynamic image analysis with 2D matrix array may significantly simplify prenatal assessment of fetal cardiac anatomy in the human fetus.