G. Pelusi

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

Prenatal diagnosis and outcome of partial agenesis and hypoplasia of the corpus callosum

To present antenatal sonographic findings and outcome of fetuses with hypoplasia or partial agenesis of the corpus callosum.

Cervical length and risk of antepartum bleeding in women with complete placenta previa

To evaluate if cervical length predicts prepartum bleeding and emergency Cesarean section in cases of placenta previa.

Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid

Background  The effects of ursodeoxycholic acid on human placental bile acids and bilirubin transporters in intrahepatic cholestasis of pregnancy are still undefined.

Persistence of increased uterine artery resistance in the third trimester and pregnancy outcome

To evaluate whether the persistence of abnormal findings in the third trimester following increased uterine artery (UtA) resistance in the second trimester is related to adverse pregnancy outcome.

Three‐dimensional sonographic diagnosis of ovarian pregnancy

Among ectopic pregnancies, ovarian ones are extremely rare. Sonographic diagnosis is feasible although differential diagnosis from the more common tubal location is difficult. Furthermore, owing to their similar sonographic appearance, even distinction from an ipsilateral corpus luteum is not straightforward. We report a case of an ovarian pregnancy that was sonographically identified in a patient with a past ipsilateral salpingectomy because of a tubal pregnancy. The role of three-dimensional (3D) ultrasound in assisting standard sonographic diagnosis is highlighted. A 35-year-old para 1 woman was admitted to our unit because of acute pelvic pain associated with a 2-week delay in menstruation. Her left Fallopian tube had been laparoscopically removed a few months previously owing to an ectopic pregnancy. At laparoscopy a massive hemoperitoneum caused by left tubal rupture had been documented and gestational tissue had been retrieved from the salpinx at pathological examination. A positive urine pregnancy test had been obtained a few hours prior to admission for her current symptoms and she was assumed to be at 6 weeks’ gestation. Her past medical history included appendicectomy and a Cesarean section owing to fetal distress. Gynecological examination documented a mildly enlarged uterus without overt vaginal bleeding or adnexal masses. On external palpation, the abdomen was mildly contracted, with no frank sign of peritoneal irritation. A blood test revealed mild sideropenic anemia (hemoglobulin 9.9 g/dL, mean cell volume 82 fL, hematocrit 28%), and 1726 IU/L of serum beta-hCG. A transvaginal ultrasound examination was performed using a Voluson 730 Exp machine (General Electrics, Milwaukee, USA) equipped with a multifrequency volumetric probe. In the standard two-dimensional (2D) view a thick endometrial lining with no intrauterine gestational sac was demonstrated. The right ovary appeared normal with no suspicious mass within the ipsilateral tube. The left ovary was mildly enlarged owing to a 30-mm unilocular hypoechoic cyst and a 22-mm irregularly-shaped mass, whose sonographically mixed content was consistent with that of a corpus luteum. At the very medial pole of the left ovary, an 18-mm round hypoechoic mass with thick and hyperechoic borders was detected. Power Doppler imaging demonstrated peripheral blood flow distributed in a ring around this mass and the corpus luteum. Mild effusion in the pouch of Douglas was also observed. Volume acquisition and 3D rendering of the left ovary were carried out, revealing a small hypoechoic mass bulging from the cortex and surrounded by a thick hyperechoic ring that was consistent with the ‘bagel’ appearance (Figure 1). Because of these sonographic findings, a small ruptured left ovarian pregnancy co-existing with a corpus luteum and a unilocular cyst was suspected. On the same day an emergency laparoscopy documented a mild blood effusion from a small bulge on the left ovarian surface that was compatible with a gestational sac (Figure 2). An ovarian wedge containing the ectopic sac was resected and removed through the endobag. The patient was discharged home the following day in good condition. Sonographic and surgical findings were pathologically confirmed a few days later. The specimen was described as a juxtacortical ovarian pregnancy associated with normal ovarian stroma. As shown in a large study from a single center1, ovarian ectopic pregnancy does not exceed 3% of all ectopic pregnancies, with almost one case expected out of 3000–40 000 livebirths2. Among the risk factors for ovarian pregnancy, endometriosis or intrauterine device usage have been commonly described3. According to developmental stage and appearance, four types are commonly acknowledged, i.e. ovarian hematoma, clear ovum, embryonized ovum < 3 months and placenta with fetus aged > 3 months4. Four types of ovarian pregnancy have been histologically described, i.e. intrafollicular, juxtafollicular, juxtacortical and interstitial4. In comparison with tubal pregnancies, the clinical presentation is slightly unusual and, as observed in our case, acute pelvic pain is expected to arise prior to 7 completed gestational weeks. Thanks to dramatic improvements in ultrasound equipment, accurate sonographic diagnosis, as confirmed

Inversion mode spatio-temporal image correlation (STIC) echocardiography in three-dimensional rendering of fetal ventricular septal defects

We read with interest the report of Yagel et al.1 addressing the use of four-dimensional (4D) color Doppler ultrasound implemented by spatio-temporal image correlation (STIC) technology in prenatal imaging of a ventricular septal defect (VSD). In their recent paper, an isolated muscular VSD is nicely documented in a 23-week fetus by means of 4D color STIC echocardiography. Diastolic shunting of blood flow through the defect is accurately displayed on a volume-rendered image of ventricular septum, whose reconstruction is carried out alternatively on coronal, axial and sagittal planes. We report here a case of an isolated VSD that was demonstrated in a mid-trimester fetus and confirmed at postnatal follow-up. A 40-year-old nulliparous woman had been referred to our ultrasound unit at 21 weeks of gestation for a detailed anomaly scan, including fetal echocardiography due to her advanced age. Extracardiac anatomy appeared unremarkable. During standard twodimensional echocardiography the suspicion of a VSD was raised by detection of color turbulence across the ventricular septum in the four-chamber view. Based on this finding, detailed imaging of the fetal heart was carried out using 4D STIC color technology. The volume dataset was acquired by a 10-s transverse sweep of 25 degrees through the fetal chest at the level of the fourchamber view. Volume reconstruction of the fetal heart was achieved in color mode focusing on the ventricular septum where a discontinuity was confirmed by diastolic shunting of blood across it (Figure 1). Further confirmation of previous findings was provided by the recently introduced inversion mode algorithm. Through this latter 4D ultrasound rendering option, blood flow shunting across the VSD was depicted as a hyperechogenic flap bridging the two ventricles in the diastolic phase of the cardiac cycle (Figure 2). Furthermore, by measuring in diastole the depth of the bridge between the ventricles (Figure 3), the defective area on the ventricular septum could be derived ((0.27/2)2 × 3.14 = 0.057 mm2). 4D echocardiography implemented by STIC technology has been recently introduced as an adjunctive option in prenatal imaging of congenital heart diseases2. As suggested by the acronym itself, STIC allows multiplanar view and volume rendering of moving structures such as fetal heart. Thanks to this algorithm, following a dynamic acquisition of a volume dataset including fetal heart, a single cardiac cycle is virtually reconstructed according to heart rate with fundamental section planes being displayed Figure 1 Volume reconstruction of four-chamber view by color spatio-temporal image correlation echocardiography: diastolic shunting through the interventricular septum is clearly depicted suggesting a ventricular septal defect (arrow).

Maternal cardiac function in normal twin pregnancy: a longitudinal study

To investigate maternal cardiac function in a cohort of uncomplicated twin gestations assessed longitudinally.

Three‐dimensional transvaginal sonography in local staging of cervical carcinoma: description of a novel technique and preliminary results

To evaluate the feasibility of three‐dimensional multiplanar sonography in the local staging of cervical carcinoma.

Three‐dimensional sonographic imaging of fetal bilateral cleft lip and palate in the first trimester

The introduction of three-dimensional (3D) ultrasound imaging has greatly improved the prenatal assessment of fetal face anomalies. We report a case of bilateral cleft lip and palate that was suspected on two-dimensional (2D) ultrasound examination during a routine first-trimester scan. The use of 3D ultrasonography enabled a more accurate depiction of the defect. A 30-year-old Caucasian primigravida attended the ultrasound department of our university hospital at 12 weeks’ gestation for nuchal translucency assessment. The ultrasound scan was performed transabdominally using a Voluson 730 Pro (GE Healthcare, Milan, Italy). Fetal biometry was compatible with the date of the woman’s last menstrual period (crown–rump length, 64 mm) and nuchal translucency was within the normal range (1.6 mm). On 2D imaging a bilateral facial cleft was suspected owing to the bulging of the premaxilla in the mid-sagittal plane of the fetal face (Figure 1). No additional anomalies were noted. Three-dimensional ultrasound assessment was carried out in order to achieve a more accurate depiction of the defect. On multiplanar imaging a cleft extending to the palate on either side was confirmed (Figure 2a). The surfacerendered coronal image of the fetal face confirmed the presence of the bilateral cleft lip and a premaxillary protrusion (Figure 2b). After counseling the couple opted for termination of pregnancy, which was carried out by forceps and curettage without fetal karyotyping. A bilateral cleft lip and palate was confirmed visually in the aborted fetus, although a systematic postmortem assessment was not feasible owing to the early gestational age and to the procedure-related specimen disruption. In expert hands 2D ultrasound examination is accurate in the prenatal detection and classification of facial clefts, leading to a correct assessment of both laterality and involvement of the palate in the vast majority of cases1–3. In our case a correct diagnosis of the defect was achieved by 2D ultrasound examination at 12 weeks of gestation. This is extremely unusual; the prenatal diagnosis of facial clefts during the second trimester is common but only a