G. Paramasivam

Radiofrequency ablation for selective reduction in complex monochorionic pregnancies

Please cite this paper as: Paramasivam G, Wimalasundera R, Wiechec M, Zhang E, Saeed F, Kumar S. Radiofrequency ablation for selective reduction in complex monochorionic pregnancies. BJOG 2010;117:1294–1298.

Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders

To investigate the indications for offering selective fetal reduction in monochorionic (MC) and dichorionic (DC) twins and to correlate obstetric outcome with the antenatal procedure.

Accuracy of prenatal diagnosis and prediction of lethality for fetal skeletal dysplasias

We reviewed all cases with fetal skeletal dysplasia and correlated the accuracy of prenatal diagnoses with the final post‐mortem, radiological, or molecular diagnoses. The accuracy of prenatal prediction of lethality was also reviewed.

Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation

We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD).

Crystal Vue technique for imaging fetal spine and ribs.

New ways of assessing the fetus are now possible owing to the introduction of three-dimensional (3D) ultrasound over a decade ago1. 3D ultrasound has been used as an easy-to-perform and accurate technique to image the fetal skeleton1–6. Garjian et al. demonstrated that 3D ultrasound can provide more information than does conventional two-dimensional (2D) imaging in the diagnosis of skeletal abnormalities, both in multiplanar and volume-rendered methods. This is particularly true when assessing short ribs and chest hypoplasias as the entire body region can be visualized and offline volume reconstruction can be performed3. Classical 2D ultrasound examination of long bones, ribs and vertebrae frequently gives insufficiently detailed images for assessment of bone contour, thickness and mineralization. Crystal Vue is a new technique based on image-contrast enhancement that can be used for processing and rendering of acquired 3D volumes. Our recent experience with Crystal Vue, specifically when imaging the bone/soft tissue interface, has led us to believe that it may offer new opportunities for prenatal imaging, particularly of the skeletal system but also of the face and brain. Here we present and compare images of the spine and ribs in a third-trimester normal fetus and those in a fetus with suspected skeletal dysplasia, examined using a Samsung WS80 Elite system (Samsung Medison Co. Ltd., Seoul, South Korea) with Crystal Vue and Realistic Vue software applications. A 39-year-old pregnant woman who had five previous healthy pregnancies was followed up at 20 weeks’ gestation after spontaneous resolution of pleural effusion and echogenic bowel. Amniotic fluid-polymerase chain reaction and array were negative as was TORCH and cystic fibrosis testing. Ultrasound examination was performed at 29 + 4 weeks’ gestation (Figure 1). On 2D imaging, the spine and ribs appeared normal with normal fetal movements and amniotic fluid. Using Crystal Vue postprocessing on a saved 3D volume, the rib/vertebral interface was seen clearly and rib mineralization appeared normal; we were able to identify 12 ribs.

Crystal vue technique for imaging of the fetal spine and ribs

New ways of assessing the fetus are now possible owing to the introduction of three-dimensional (3D) ultrasound over a decade ago1. 3D ultrasound has been used as an easy-to-perform and accurate technique to image the fetal skeleton1–6. Garjian et al. demonstrated that 3D ultrasound can provide more information than does conventional two-dimensional (2D) imaging in the diagnosis of skeletal abnormalities, both in multiplanar and volume-rendered methods. This is particularly true when assessing short ribs and chest hypoplasias as the entire body region can be visualized and offline volume reconstruction can be performed3. Classical 2D ultrasound examination of long bones, ribs and vertebrae frequently gives insufficiently detailed images for assessment of bone contour, thickness and mineralization. Crystal Vue is a new technique based on image-contrast enhancement that can be used for processing and rendering of acquired 3D volumes. Our recent experience with Crystal Vue, specifically when imaging the bone/soft tissue interface, has led us to believe that it may offer new opportunities for prenatal imaging, particularly of the skeletal system but also of the face and brain. Here we present and compare images of the spine and ribs in a third-trimester normal fetus and those in a fetus with suspected skeletal dysplasia, examined using a Samsung WS80 Elite system (Samsung Medison Co. Ltd., Seoul, South Korea) with Crystal Vue and Realistic Vue software applications. A 39-year-old pregnant woman who had five previous healthy pregnancies was followed up at 20 weeks’ gestation after spontaneous resolution of pleural effusion and echogenic bowel. Amniotic fluid-polymerase chain reaction and array were negative as was TORCH and cystic fibrosis testing. Ultrasound examination was performed at 29 + 4 weeks’ gestation (Figure 1). On 2D imaging, the spine and ribs appeared normal with normal fetal movements and amniotic fluid. Using Crystal Vue postprocessing on a saved 3D volume, the rib/vertebral interface was seen clearly and rib mineralization appeared normal; we were able to identify 12 ribs.

Diaphragmatic hernia: a postnatal complication of anomalous drainage of the umbilical vein.

The ductus venosus (DV) connects the portal venous system to the inferior vena cava. Rarely, the umbilical venous drainage is anomalous, either connecting to the portal sinus within the liver or having an extrahepatic connection, bypassing the liver and draining to one of a variety of sites, including to the heart directly. Prenatally, there is a recognized association of anomalous umbilical venous drainage with aneuploidy and other structural malformations. The fetus may also develop right heart failure because of unregulated volume loading. We report the postnatal development of diaphragmatic hernia in three fetuses with absent DV and umbilical venous drainage to the right atrium directly in two cases and to the coronary sinus in the third. In all fetuses, the abnormality was well‐tolerated in pregnancy, with only a modest degree of right heart dilatation. All three neonates underwent repair of the diaphragmatic hernia and made a good recovery. Copyright

Qualitative evaluation of Crystal Vue rendering technology in the assessment of fetal lip and palate

Facial clefts of the lip and alveolar ridge are usually evaluated with conventional ultrasound imaging. However, assessment of the extension of the defect into the palate and the detection of isolated clefts of the secondary palate is often not always possible due to poor acoustic windows. Nevertheless, knowledge of the extent of the cleft has significant prognostic implications in terms of pregnancy choices, surgical and functional outcome. Newly developed three-dimensional (3D) technologies offer the opportunity to develop novel imaging techniques for the evaluation of the secondary palate, although these have not been objectively compared. Crystal Vue (CV) is a recently developed ultrasound 3D post processing rendering technology based on image-contrast enhancement which is capable of preserving context and surface information. In this study we qualitatively describe its performance in the assessment of the fetal lip and palate and compare our findings to those reported using other 3D methods.

Managing the difficult case of fetal anemia

Objectives. To describe a series of complex fetal anemia cases, detail the appropriate investigations and management, and review the literature. Methods. Four cases of non-red cell alloimmunization or infective cases of fetal anemia are presented. Results. Of the four cases presented, one was a neonatal death, one pregnancy was terminated, one case was diagnosed with Diamond Blackfan anemia, and one case was due to recurrent feto-maternal hemorrhages despite negative Kleihauer tests. Conclusions. Non-alloimmune causes of fetal anemia can be difficult to manage. Some cases require repeated and frequent intrauterine transfusions. The perinatal mortality and preterm delivery rates are increased, and some cases require considerable long-term treatment including regular transfusions. We present our experience of a series of non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.

Fetal transverse limb defects: Case series and literature review

To investigate the incidence and outcome of antenatally diagnosed isolated transverse limb defects at a major tertiary center and to review the literature relevant to this rare condition.