Chizu Yamashiro

Three-dimensional sonographic assessment of fetal behavior in the early second trimester of pregnancy.

To evaluate the fetal behavior pattern in the early second trimester of pregnancy by use of specially developed abdominal dynamic three‐dimensional sonography.

Three‐dimensional sonographic features of fetal central nervous system anomaly

Objective. To visualize an intracranial structure of the fetal central nervous system (CNS) anomaly using transabdominal three‐dimensional (3D) sonography.

Three-dimensional sonographic measurement of liver volume in the small-for-gestational-age fetus

To assess the growth of the fetal liver in normal pregnancies and to evaluate the ability of fetal liver volume measurement for prediction of small‐for‐gestational‐age fetuses.

Naturally conceived twin pregnancy with hyperreactio luteinalis, causing hyperandrogenism and maternal virilization

Hyperreactio luteinalis (HL) is a marked cystic enlargement of the ovary due to multiple benign theca lutein cysts (1). It is an uncommon condition, and the cause of this disorder is not well known. HL is believed to be induced by elevated serum levels of human chorionic gonadotropins (hCG) (1). It occurs commonly in pregnant patients with trophoblastic disease, occasionally in multiple pregnancies, and rarely in normal pregnancy (2). Maternal virilization occurs in approximately 15% of cases with HL (3). We herein report a case of HL with maternal virilization in spontaneously conceived twin pregnancy. We also report twoand three-dimensional ultrasonographic and MRI features of HL, and discuss its management.

Three‐dimensional sonographic volume measurement of the fetal spleen

Aim:  The objective of this longitudinal study was to evaluate the growth of the fetal lung in normal pregnancies, using 3‐D ultrasound.

Plasma adrenomedullin levels in pregnancies with appropriate for gestational age and small for gestational age infants

Abstract Aims: To evaluate whether maternal and fetal plasma adrenomedullin levels in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants. Methods: Maternal and fetal circulating adrenomedullin levels were compared between 62 pregnancies with AGA (43 delivered vaginally and 19 delivered by elective cesarean section) and 28 pregnancies with SGA (20 delivered vaginally and 8 delivered by elective cesarean section) at birth. Plasma adrenomedullin levels were measured from maternal and cord venous blood samples using a radioimmunoassay. Umbilical artery blood pH was also measured. Results: There were no significant differences for maternal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. There were also no significant differences for fetal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. In the AGA group delivered vaginally, fetal mature/total adrenomedullin ratio (mean ± standard error, 16.6 ± 0.7%) was significantly higher than the maternal ratio (13.8 ± 0.6%) (p < 0.05). In the SGA group delivered vaginally, fetal mature/total adrenomedullin ratio (18.5 ± 1.0%) was also significantly higher than the maternal ratio (14.5 ± 0.6%) (p < 0.05). There was no significant difference in umbilical artery blood pH among the groups. Conclusions. These results suggest that maternal and fetal plasma circulating adrenomedullin levels may play a role in maternal and fetal cardiovascular adaptation during delivery in pregnancies with both AGA and SGA infants.

Subclassification of small-for-gestational-age fetus using fetal Doppler velocimetry.

Our purpose was to determine whether small-for-gestational-age (SGA) fetus can be divided to subclassified groups using fetal Doppler velocimetry. Fifty-four pregnant women with SGA infant delivered after 37 weeks of gestation were studied. After 24 weeks of gestation, fetal middle cerebral artery puslatility index (MCAPI) and umbilical artery pulsatility index (UAPI) were measured at 2- to 3-week intervals using Doppler ultrasound. Perinatal outcomes [operative delivery due to fetal distress, abnormal fetal heart rate (FHR) pattern, meconium staining, low Apgar score (<7), neonatal acidosis (umbilical artery blood pH <7.15), neonatal intensive care unit (NICU) admission due to neonatal asphyxia, and decreased amniotic fluid] were compared in subclassified SGA groups using fetal Doppler velocimetry. The number of SGA fetuses with normal MCAPI and UAPI (normal SGA group) was 39, and those with significantly low MCAPI but normal UAPI (eventful SGA group) 15, respectively. Birth age and birth weights in the eventful SGA group were significantly earlier and lower than those in the normal SGA group, respectively (p < 0.05, and p < 0.005). There were significant increases in operative deliveries, abnormal FHR patterns and decreased amniotic fluid in eventful SGA group, when compared with events related to normal SGA group. However, there were no significant differences in meconium staining of amniotic fluid, low Apgar score, neonatal acidosis, and NICU admission between the two groups. These results suggest that SGA fetus with abnormally low MCAPI but normal UAPI has more poor perinatal outcomes, compared with that with normal MCAPI and UAPI.

Three-dimensional sonographic volume measurement of the fetal cerebellum

PurposeThe objective of this longitudinal study was to evaluate the growth of the fetal cerebellum in normal pregnancy by using three-dimensional ultrasound.MethodsThree-dimensional sonographic examinations were performed for 13 appropriate-for-gestational-age fetuses. Fetal cerebellar volume was measured every 2 to 3 weeks after 20 weeks of gestational age until delivery. The common multiplanar technique was used to calculate the fetal cerebellar volume.ResultsA curvilinear relationship was found between gestational age and cerebellar volume (R2 = 78.6%, P < 0.0001), and normal ranges of cerebellar volume measurements for estimating the growth of the fetal cerebellum during normal pregnancy were generated. The data gathered in this study were fairly comparable with previous data obtained using three-dimensional ultrasound. However, the normal ranges of cerebellar volume that we determined were relatively wide throughout pregnancy.ConclusionsOur findings suggest that a standard curve for fetal cerebellar volume using three-dimensional ultrasound can play a role in the evaluation of normal cerebellar growth in the fetus. However, we do cast doubt on the reliability and reproducibility of cerebellar volume measurement using three-dimensional ultrasound. Further studies involving a larger sample size and another technique (the rotational method with VOCAL) would be needed to confirm these findings.

3D and 4D sonographic imaging of amniotic band syndrome in early pregnancy.

We present a case of amniotic band syndrome diagnosed with two‐dimensional (2D), three‐dimensional (3D), and four‐dimensional (4D) sonography at 14 weeks and 5 days of gestation. Conventional 2D sonography revealed multiple amniotic bands, fetal acrania, deformed hand, gastroschisis, kyphoscoliosis, and club foot. 3D and 4D sonography revealed multiple amniotic bands swinging in the amniotic cavity with 1 of them attached to the fetal head, and the severe deformity of the fetal face.

Antenatal three-dimensional sonographic features of Pierre-Robin syndrome: Case report

A case of Pierre-Robin syndrome with polyhydramnios is described. Three-dimensional sonography clearly showed fetal micrognathia and hypoplastic ear antenatally. The benefits and advantages of the use of three-dimensional sonography to diagnose Pierre-Robin syndrome in utero are discussed.