Baruch Messing

First and early second trimester fetal heart screening

Purpose of review This review describes the recent advances in timing and effectiveness of first and early second trimester fetal echocardiography screening. Recent findings Fetal echocardiography can now be reliably performed from 11 weeks gestation owing to improvements in ultrasound transducers and processors. Three-dimensional and four-dimensional ultrasound modalities in image acquisition and postprocessing analysis, including spatio-temporal image correlation, rendering three-dimensional power Doppler and high definition power flow Doppler, and B-flow have further improved our capabilities in this area. Fetal nuchal translucency measurement screening programs create a new population of at-risk pregnancies that will be referred for early fetal echocardiography. The majority of congenital heart defects, however, still occur in low-risk patients. Improved technology has lowered the gestational age at which fetal cardiac anatomy scanning can be reliably performed by properly trained and experienced examiners. Summary Early fetal echocardiography can be offered as a screening examination to at-risk and low-risk patients, with the proviso that it be repeated following screen-negative scans at mid-gestation to exclude later developing lesions.

Mild tricuspid regurgitation: a benign fetal finding at various stages of pregnancy

Objective nTricuspid regurgitation (TR) may accompany various anatomical malformations and/or dysfunction of the fetal right heart. It may also appear in an anatomically healthy heart. With improved ultrasound modalities, more cases than the previously estimated prevalence of fetal TR in the low-risk population are being diagnosed. The objective of this study was to determine the prevalence of mild fetal TR in a low-risk obstetric population. n nMethods nIn 157 low-risk pregnant women (age range, 18–42 years) undergoing both early second-trimester and mid-trimester targeted organ scanning, including complete fetal echocardiography according to the five transverse planes technique, the apical four-chamber view was visualized using gray-scale, color Doppler and spatiotemporal image correlation (STIC) ultrasound modalities, with optimal acquisition parameters. n nResults nMild-to-moderate TR was discovered in the early second-trimester scan in 131/157 (83.4%) fetuses. No cases of cardiac malformation were found. All fetuses showed normal flow in the ductus venosus, including in one case diagnosed with moderate TR. Only in 39 (24.8%) cases was mild TR still evident at the second, mid-trimester scan. Neonatal echocardiography revealed mild TR in eight (5.1%) cases. No cases of chromosomal anomalies were detected. n nConclusion nMild TR is a benign finding of a temporal nature in early pregnancy. Copyright

Three-dimensional and four-dimensional ultrasound applications in fetal medicine.

PURPOSE OF REVIEWnTo describe the state of the science of three-dimensional/four-dimensional ultrasound (3D/4DUS) applications to fetal medicine.nnnRECENT FINDINGSn3D/4DUS applications are many and varied. Their use in fetal medicine varies with the nature of the tissue to be imaged and the challenges each organ system presents, versus the advantages of each ultrasound application. We will here describe the research and clinical use of 3D/4DUS applications in fetal medicine today, as they are applied to greatest benefit to various organ systems.nnnSUMMARYn3D/4DUS has been extensively applied to the study of the fetus. Fetal applications include all types of anatomical assessment, morphometry and volumetry, as well as functional assessment. 3D/4DUS provides many advantages in fetal imaging; however, its contribution to improving the accuracy of fetal scanning over rates achieved with 2DUS, remains to be established.

Mild tricuspid regurgitation: a benign fetal finding at various stages of pregnancy: Mild tricuspid regurgitation

Tricuspid regurgitation (TR) may accompany various anatomical malformations and/or dysfunction of the fetal right heart. It may also appear in an anatomically healthy heart. With improved ultrasound modalities, more cases than the previously estimated prevalence of fetal TR in the low‐risk population are being diagnosed. The objective of this study was to determine the prevalence of mild fetal TR in a low‐risk obstetric population.

Detailed Transabdominal Fetal Anatomic Scanning in the Late First Trimester Versus the Early Second Trimester of Pregnancy

To compare visualization rates for early targeted organ scanning at gestational ages ranging from 11 weeks 3 days to 13 weeks 2 days versus 14 weeks 3 days to 16 weeks 2 days.

Prenatal Anogenital Distance Is Shorter in Fetuses With Hypospadias: Anogenital Distance and Fetal Hypospadias

Recent research provides evidence that anogenital distance may serve as a novel metric to assess reproductive potential in men. In children, a shorter anogenital distance was linked with cryptorchidism, hypospadias, and micropenis. Scarce data exist in the literature regarding anogenital distance measurement in the fetus. The aim of our study was to assess whether intrauterine measurement of fetal anogenital distance could assist in the differential diagnosis of male genital anomalies.

Persistence of Levator Ani Sonographic Defect Detected by 3DTUS in Primiparous Women

Correlation of the sonographic appearance of levator ani muscle (LAM) injury soon after delivery with that at long‐term follow‐up has not been described fully. We aimed to compare results of three‐dimensional (3D) transperineal sonographic (TPS) evaluation of the LAM from the period immediately postpartum with long‐term follow‐up, to determine whether sonographic findings persist over time.

4D Fetal Echocardiography

Congenital heart defects (CHD) are the most frequent malformation in the human fetus and are the leading cause of mortality due to malformations in the first year of life. Despite its clinical importance screening performed by ultrasonographic examination during the second trimester of pregnancy has shown disappointingly low detection rates mainly due to the difficulties in obtaining an adequate examination of the fetal heart. Four-dimensional (4D) ultrasound of the fetal heart has been recently suggested as a tool to improve the detection rate of CHD by decreasing the dependency on operator skills required in two-dimensional ultrasound scans but up to now no practical manuals are available in describing its application in clinical practice for the study of fetal heart. The objective of this Ebook is to explain the role of 4D during second trimester examination and in fetuses with CHD. The technique of obtaining 4D volume of the fetal heart, how to navigate in the volume to obtain diagnostic planes and how to use semiautomatic and automatic software of analysis are described. We believe that after reading this book the standard fetal cardiac anatomy survey can be performed in the second trimester fetus by 4D in both normal and abnormal hearts. This approach may reduce the operator dependency in diagnosis CHD. This Ebook should prove to be a valuable resource for obstetricians, sonographers and pediatric cardiologists.