Biserka Funduk-Kurjak

Prenatal diagnosis: what does four-dimensional ultrasound add?

Abstract Introduction: The key benefit of 4D ultrasound lies in providing real-time 3D images of embryonic or fetal movements, previously limited by technological advancement. Aim: To classify types of first trimester embryonic and fetal movements in normal pregnancies as seen by 4D sonography. Results: Three types of movements can be visualized in the first trimester: gross body between seven and eight weeks, limb movements after ten weeks and complex limb movements after 11 weeks of gestation. Discussion: An alteration from the given pattern of motoric development should be considered as an indication for further investigation. Conclusion: 4D ultrasound enables visualization of more details of the dynamics of small anatomical structures. Therefore, body and limb movements can be visualized a week earlier than with 2D.

Limb deformities and three-dimensional ultrasound

Abstract Aim: To assess the ability of three-dimensional (3D) ultrasonography for improvement of antenatal detection of limb deformities. Methods: 347 patients were selected from a routine outpatient clinic or sent for supervision from other units because of suspected anomalies of fetal extremities. 3D ultrasound devices used in the study were Combison 530D and Voluson 530D MT (Kretztechnik, Zipf, Austria) with a 3–5 MHz annular array transducer for three-dimensional volume scanning. Results: In 41 of 347 patients the initial diagnosis was suspected by two-dimensional sonography (gestational age 18–32 weeks). In 28 of 41 suspected cases the diagnosis of abnormalities was determined after examination by 3D sonography: 17/28 clubfoot, 3/28 hand-polydactily, 2/28 upper limb contractures, 1/28 lower limb contractures, 4/28 micromelia within the syndrome of skeletal dysplasia. In 13 of 41 suspected cases, normal anatomy was confirmed using 3D sonography. Conclusion: Three-dimensional sonography is the “method of choice” for the detection of an isolated defect of a single limb, developmental or positional deformations and minor defects of hands and feet. Surface-mode reconstruction of the complete limb and transparent-view reconstruction of the entire skeletal structure are effective technical advantages enabling a completely new visual perception of the unborn baby.

Assessment of early chorionic circulation by three-dimensional power Doppler

Abstract Three-dimensional power Doppler sonography is a unique instrument that enables assessment of vascular signals within the whole investigated area. Hemodynamical changes included in the process of early placentation are one of the most exciting topics in investigation of early human development. This investigation was designed as an observational cross-sectional study. A group of 25 patients in gestational age five to eleven weeks were recruited for the study. After acquirement of the volume containing three-dimensional power Doppler data of the pregnant uterus, the signals belonging to the chorion were isolated. Vascular 3D measurements were undertaken through 3D color/power histogram and expressed by Vascularization Index (VI) and Vascularization Flow Index (VFI). Volume of the chorion increased exponentially throughout the observation period. The VI and VFI positively correlated with the crown-rump length and chorion volume, and showed gradual increment through the investigation period. This investigation produced results confirming gradual augmentation of the loci and intensity of the intervillous flow in pregnancies between five and eleven gestational weeks.

Transvaginal color Doppler in the assessment of the uteroplacental circulation in normal early pregnancy

Transvaginal color Doppler investigation of the uteroplacental circulation was performed on 108 pregnant women with normal intrauterine pregnancy. Decline of resistance index (RI) and pulsatility index (PI) and increase of peak systolic velocity (Ps velocity) were found in all segments of the uteroplacental circulation with advancing gestational age. There was a decrease of RI and PI from the uterine artery through its branches: arcuate, radial and spiral arteries. Ps velocities decreased from the uterine, through the arcuate, to the radial arteries, but Ps velocities in the spiral arteries were higher than those in the radial arteries. According to our results RI seems to be more precise in the assessment of the uteroplacental than the PI.

Ultrasonic markers of fetal chromosomal abnormalities

OBJECTIVE The aim of this brief investigation was to correlate the most common sonographically detectable markers with certain type of chromosomal disorder diagnosed by available karyotyping procedures. STUDY DESIGN During the 3 year study period fetal karyotyping was performed in 1055 patients for a variety of clinical indication. Twenty one percent (21%; 222/1055) of procedures were done because of sonographically detectable structural disorders related to phenotype expression of chromosomopathies. Sonographic examinations and karyotyping procedures were performed between the 10th and 36th week. The average maternal age was 27 years, unselected. RESULTS The fetal karyotype was abnormal in 13.5% of cases (30/222). Within the group of single marker, 11.6% (7/60) of karyotypes were abnormal. Multiple markers of chromosomal abnormalities resulted in 14.2% (23/162) of abnormal karyotypes. The most frequent chromosomal disorder detected in sonographic screening is trisomy 18 (50%; 15/30). The data on the frequency of different types of chromosomal abnormalities are given. CONCLUSIONS The incidence of chromosomal abnormalities for ultrasonographically detectable malformations is much higher than the incidence reported in screening studies based on maternal age or biochemical screening. Trisomy 21 showed the relative lack of variety in phenotypic expression, and nuchal translucency screening has to be accepted rationally. Associated numerous major and minor malformations were the most prominent factors leading to the diagnosis of chromosomopathies, particularly trisomy 18.

Early detection of fetal abnormalities by three-dimensional sonography

ABSTRACTThe first generation of three-dimensional technology, during the early 1980s, provided a pseudo-three-dimensional image by the simultaneous display of the three orthogonal planes and offered some advantages over conventional two-dimensional imaging. Modern systems are capable of generating surface and transparent views depicting the sculpture-like reconstruction of fetal surface structures and transparent images of fetal inner anatomy. Three-dimensional scanning offers advantages in assessing embryonic morphology in the first trimester, owing to the ability to obtain multiplanar images through endovaginal volume acquisition. The three-dimensional possibility of rotation of the scanned object and close analysis of the scanned volume have allowed more systematic review of embryonic and extraembryonic anatomy. During the second and third trimesters, three-dimensional sonography provides a completely new way of visual perception of the unborn baby. Reconstructions and sculpture-like images, generated ...

WS14: Three‐dimensional power Doppler in obstetrics and gynecology WS14‐01 3‐D ultrasound in routine check‐up of infertility patients

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