F. F. Correa

Examination of the fetal brain by transabdominal three-dimensional ultrasound: potential for routine neurosonographic studies.

To evaluate the role of transabdominal three‐dimensional (3D) ultrasound in the assessment of the fetal brain and its potential for routine neurosonographic studies.

Mastoid fontanelle approach for sonographic imaging of the neonatal brain

This pictorial review describes in detail the examination technique used to study the neonatal brain via the mastoid fontanelle and offers a panoramic view of the anatomical structures that can be identified in each US slice. The brain lesions are grouped as congenital malformations, haemorrhage, cerebellar lesions and sinus venous thrombosis. In each section, the additional information obtained through the mastoid fontanelle is provided.

An anatomical fetal brain structure and a normal variant mimicking anomalies on routine neurosonographic imaging: report of two cases

We present two cases in which an anatomical structure, the calcar avis, and a normal variant, a bifid choroid plexus, mimicked abnormalities on routine prenatal ultrasound examination. To the best of our knowledge these pitfalls have only been described in neonates. A familiarity with these false images is important to avoid erroneous diagnoses. Copyright

Anterior and posterior complexes: a step towards improving neurosonographic screening of midline and cortical anomalies.

To describe the anatomical structures that form the anterior (AC) and posterior (PC) complexes of the fetal brain and to categorize their anomalies in fetuses with cerebral abnormalities.

Two-Dimensional Ultrasound Evaluation of the Fetal Cerebral Aqueduct: Improving the Antenatal Diagnosis and Counseling of Aqueductal Stenosis

Objective: To describe a technique for the visualization and measurement of cerebral aqueduct diameter through a 2D sagittal median plane, and to report its aspect and measurement in fetuses with aqueductal stenosis (AS). Methods: This was a cross-sectional study of 207 morphologically normal fetuses in low-risk pregnancies between 20 and 36 weeks of gestation. The cerebral aqueduct was visualized transvaginally in a midsagittal plane, and measurements of its greatest diameter (ampulla) were taken independently by an expert and a nonexpert sonographer. In addition, the aqueduct morphology from 7 fetuses with AS and complete follow-up were compared to the reference range. Results: Aqueductal measurements were obtained in 206 of 207 normal fetuses. Aqueductal growth occurred linearly with gestational age. Our method demonstrated excellent interobserver reproducibility. Among the 7 fetuses with AS, the aqueductal lumen could not be identified in 6 and had a funneling aspect in 1. Discussion: Our study demonstrated that it is possible to visualize and measure the cerebral aqueduct directly through a 2D ultrasound median plane. In fetuses with severe ventriculomegaly, the morphology and width of this structure could represent a relevant tool in improving AS diagnosis, differentiating it from other causes of significant ventricular dilation that carry a different outcome.

Proximal Cerebral Hemisphere: Should We Continue to Assume Symmetry or Is It Time to Look at It Routinely?

Dear Editor, According to the guidelines of the International Society of Ultrasound in Obstetrics and Gynecology, ‘in the standard transventricular plane only the hemisphere on the far side is usually clearly visualized, as the hemisphere close to the transducer is frequently obscured by artifacts. However, most severe cerebral lesions are bilateral or associated with a significant deviation or distortion of the midline echo, and it has been suggested that in basic examinations symmetry of the brain is assumed’ [1] . Nevertheless, some abnormal conditions of development can affect only one hemisphere, such as unilateral or asymmetric ventriculomegaly, vascular clastic insults (schizencephaly [2] , parenchymal or subependymal haemorrhage, infarct, lenticulostriate vasculopathy and porencephaly), cerebral malformations (heterotopia [3] and polymicrogyria), subependymal pseudocysts, white matter disease, calcifications and tumours. Consequently, if the affected side is proximal to the transducer, the abnormality may not be noticed by the operator during the basic examination. In order to improve the detection of the spectrum of central nervous system anomalies, particularly those unilaterally affecting the hemisphere proximal to the transducer, we suggest angling the transducer Received: July 19, 2015 Accepted: July 27, 2015 Published online: September 11, 2015

P09.25: 2D/3D ultrasound diagnosis of ectrodactyly at 14 weeks of gestation

– Healthy woman, 35 years old, Gravida2 para1, (Cesarean section four years ago performed by fetal malpresentation). In this recent pregnancy, the delivery occurred at 40 weeks of gestation by Vacuum and Forceps. The neonate was born with 4015g, I.A. 7/9. The succenturiata placenta was expelled late but spontaneously. The bleeding after was heavily and the woman was submitted a curettage of uterine cavity. This procedure was difficult (because a supposed myoma nodule) and no products were obtained. Meanwhile the anemia was present and needed 2U more 2U packed red cells transfusion. – Twenty hours after delivery, sonography was requested because the hemorrhage not stopped. – The examination was performed with GE Voluson 730. The images obtained strongly suggested Incomplete Uterine Inversion. – The woman was submitted a laparotomy and was confirmed the sonographic diagnosis of incomplete uterine inversion and yet a little rupture of the uterus (right1/3 of the scar of previous histerorraphy). – The reposition of the inverted uterus was very difficult (because the existence of a strong constriction ring) but possible. Next, it was performed the hysterorraphy and tubal sterilization.

P01.28: Analysis of nuchal translucency measurements in pregnancies achieved by assisted reproduction techniques

nasal bone was 13%, combined ultrasound & biochemical detection rate was 91%. 15/17 fetus with trisomy 21 were detected (88.8%) with 9.4% false positive results (4.7% in women younger 35) (cut off 1/250). Conclusion: Combined screening in the first trimester of pregnancy is an efficient approach for detection of fetal chromosomal diseases. Screening in the first trimester is more effective than in the second trimester of pregnancy.

P01.46: The incidence and characteristics of first‐trimester fetal lateral neck cysts

Objective: To survey the accuracy of fetal gender determination during the first-trimester screening and scan for congenital anomalies. Method: A prospective observational study was performed on 496 singleton pregnancies at the first-trimester ultrasound screening. The doctor was certified by The Fetal Medicine Foundation (FMF). Ultrasound examination was performed on a GE Voluson 730 Pro transabdominally between 11–13 + 6 weeks. Both transverse and mid-sagittal planes of section of the fetal genital tubercle were done to identify the gender. The subsequent gender at birth was obtained from the karyotyping reports or the hospital birth records. Results: During the study 496 patients requested gender information at the time of first-trimester screening. Of those patients where it was possible to determine gender (441 out of 496) the scan achieved an overall success rate of 92.3% in correctly identifying gender. It was found that both transverse and mid-sagittal planes to identify fetal gender were necessary to improve determination. When the crownrump length was 45.0–56.0 mm, the accuracy rate was 75.4%, when the crown-rump length was 57.0–67.0 mm, the accuracy rate was 92.0% (P < 0.001), when the crown-rump length was 68.0–84.0 mm, the accuracy rate was rose to 98.3% (P < 0.001). The fetal gender accuracy rate for male fetus was slightly better than female (93.4% vs 91.2%) but is not statistically significant. Conclusion: This study demonstrated that the 11–13 + 6 weeks scan achieved an overall adjusted accuracy of 82.1% in correctly determining fetus gender. The gestation age of the fetus had a material effect on the accuracy rate of gender determination.

P03.04: The influence of mode of conception, fetal gender and twin pregnancy in the development of cerebral structures: a fetal brain 3D ultrasound study

Objective: To describe the frequency, gestational age at diagnosis and biometrical data of different types of holoprosencephaly (HP) and their associated malformations and chromosomal disorders. Methods: Retrospective analysis of 51 cases diagnosed with fetal HP at two tertiary referral centers for prenatal diagnosis over a 14 years period. Results: The mean gestational age at diagnosis was 21 + 6 weeks, which decreased from 24 + 4 weeks in the first period (1990–1997) to 20 + 0 weeks in the second period (1998–2004). Conversely, first-trimester diagnosis increased from the first to the second period (5.8% vs. 23.5%). A fetal head circumference < 5th centile was found in 71% of fetuses in the second trimester and 92% of fetuses in the third trimester. Alobar HP (49%) was the most commonly diagnosed type of holoprosencephaly. 82% of fetuses had associated malformations, in particular cardiac defects, midline facial defects and polydactylia. Chromosomal disorders were found in 65% of fetuses, of those 76% had trisomy 13. The diagnosis of HP was postnatally confirmed in 81% of cases. In the remaining 19% other, comparable severe brain malformations were found. Conclusion: There is a sufficient high correlation between prenatal diagnosis and postnatal results. Diagnosis is increasingly made in the first and early second trimester. Abnormal small head circumference is a frequent sign of HP in the late second and third trimester.