Ingrid Schwach Werneck Britto

Reference Range of Fetal Renal Volume by Three-Dimensional Ultrasonography Using the Vocal Method

Objective: To establish reference values for fetal renal volume by three-dimensional sonography using the VOCAL (Virtual Organ Computer-Aided Analysis) method. Methods: This prospective longitudinal study involved 57 healthy pregnant women who were examined between 24 and 34 weeks of pregnancy. Each fetal kidney was evaluated separately using the VOCAL method with a 30° rotation angle. For each gestational age, the following measures were obtained for the right and left kidneys: mean, standard deviation, minimum and maximum values, and the 5th, 10th, 25th, 50th, 75th and 90th percentiles. Polynomial regression models were constructed to assess the relationship between renal volume and gestational age, adjusted by the determination coefficient (R2). The Wilcoxon test was used to evaluate the concordance between the right and left renal volumes. Bland-Altman graphs were used to assess intra- and inter-observer variability. Results: The right renal volume increased from 4.5 ± 1.3 cm3 at 24 weeks to 12.1 ± 1.5 cm3 at 34 weeks. The left renal volume increased from 4.6 ± 0.8 cm3 at 24 weeks to 11.9 ± 1.1 cm3 at 34 weeks. There was a strong correlation between both the right and left renal volumes and gestational age (R2 = 0.975 and 0.970, respectively). There were no significant differences between the right and left renal volumes. The mean difference between repeated measures by the same examiner was –0.07 cm3 (–0.88 to 0.75) for the right kidney and –0.21 cm3 (–0.95 to 0.75) for the left kidney. The mean difference between repeated measures obtained by two different examiners was –0.07 cm3 (–1.25 to 1.12) for the right kidney and 0 cm3 (–1.53 to 1.53) for the left kidney. Conclusion: Reference values were generated for fetal renal volume assessed by three-dimensional ultrasonography using the VOCAL method.

Reference range of fetal lung volume by 3D-ultrasonography using the rotational method (VOCAL).

Abstract Aim: To determine reference ranges for fetal lung volume by 3-dimensional ultrasonography using the VOCAL (Virtual Organ Computed-aided Analysis) method. Methods: A longitudinal prospective study was conducted with 61 uncomplicated pregnancies between 24 and 32 weeks of gestation. A separate measurement of both lungs volume was conducted by VOCAL with 30° rotation angle. For each gestational age, an average, standard deviation and maximal and minimal values were established in addition to the percentiles 5, 10, 25, 50, 75 and 90 for right and left lung volume. To evaluate the correlation between lung volume and gestational age, and estimated fetal weight, a polynomial regression with determination coefficient adjustment (R2) was used. The intra-observer reproducibility was evaluated by the intraclass correlation coefficient (ICC), whereas the inter-observer reproducibility was evaluated by Cronbach alpha statistic test. Results: The average right lung volume varied from 12.5±0.7 cm3 at the 24th week to 31.8 cm3±1.8 cm3 at the 32nd week. The average left lung volume varied from 9.2±0.9 cm3 at the 24th week to 22.0 cm3±1.6 cm3 at the 32nd week. We observed a strong correlation between right lung volume and gestational age (R2=0.975) and estimated fetal weight (R2=0.905), as well as between the left lung volume with gestational age (R2=0.970) and estimated fetal weight (R2=0.908). We observed a good intra-observer reproducibility for the right lung volume (ICC=0.990) and for the left lung volume (ICC=0.986). Similarly, we observed good inter-observer reproducibility for right lung volume (0.975) and left lung volume (0.962). Conclusion: Reference range of fetal lung volume by 3D-ultrasonography using the VOCAL method was determined.

Longitudinal assessment of lung area measurements by two‐dimensional ultrasound in fetuses with isolated left‐sided congenital diaphragmatic hernia

To evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two‐dimensional (2D) ultrasound.

Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia Impact on the Reproducibility and Efficacy to Predict Outcomes

The purpose of this study was to evaluate the impact of standardization of the lung‐to‐head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility.

Reference Ranges for 2-Dimensional Sonographic Lung Measurements in Healthy Fetuses A Longitudinal Study

The purpose of this study was to establish reference ranges for 2‐dimensional sonographic measurements of fetal lungs from longitudinal data.

New anatomical landmarks to study the relationship between fetal lung area and thoracic circumference by three-dimensional ultrasonography

Objective: To evaluate the relation between total lung area (TLA) and thoracic circumference (TC) ratio by three-dimensional (3D) ultrasonography applying new anatomical landmarks as the fetal aorta and inferior angle of the scapula. Methods: A longitudinal prospective study was conducted with 56 uncomplicated pregnancies between 24 and 32 weeks of gestation. Polynomial regressions were used to evaluate the correlation between TC and gestational age (GA) as well as TC and estimated fetal weight (EFW). A simple linear regression was used to evaluate the correlation between TLA and Total thoracic area (TTA) and GA. The intraclass correlation coefficient (ICC) was used to assess the intra and interobserver variability. Results: 127 examinations were performed. TC values ranged from 150 to 174 mm (mean 166 mm) at 24 weeks and 215–248 mm (mean 231 mm) at 32 weeks. The TLA/TC ratio ranged from a mean of 0.64 at 24 weeks (range 0.56–0.70) to 0.90 at 32 weeks gestation (range 0.79–1.01). The intraobserver variability using the ICC was of 0.919 for TC; 0.916 for TTA; 0.860 for right lung area (RLA) and 0.910 for left lung area (LLA). Interobserver reproducibility was with an ICC of 0.970 for TC; 0.984 for RLA and 0.910 for LLA. Conclusions: Measurement of fetal TC and the relationship between TLA and TC by 3D-ultrasonography applying new anatomical landmarks shows good reproducibility and allows a new assessment of thoracic and lung growth.

Prenatal Diagnosis and Perinatal Outcomes of Congenital Megalourethra A Multicenter Cohort Study and Systematic Review of the Literature

The purpose of this study was to evaluate the prenatal findings and postnatal outcomes in fetuses with congenital megalourethra.

P28.02: Nomogram of fetal lung volume by three‐dimensional ultrasound using the VOCAL method

Objective: To compare the multiplanar and VOCAL (Virtual Organ Computer-aided Analysis) methods in the assessment of embryo volume in the first trimester of pregnancy. Methods: An observational cross-sectional study was performed in 74 pregnant women between 7 and 10 weeks of gestation, using SONOACE 8000 LIVE (Medison, Seoul, Korea) with a multiple frequency endocavity transducer (3D5-8EK). Embryo volume was measured on three-dimensional ultrasound by the VOCAL method using 300 rotational angles (the contour was drawn manually) and by the multiplanar method using sequential sections of the embryo obtained at intervals of 2.0 mm. To evaluate the relation between embryo volume and gestational age, Pearson’s correlation coefficient (r) was used. The intraclass correlation coefficient (ICC) and paired Student’s t-test (P) were used to compare both methods. Results: There was strong correlation between embryo volume and gestational age (r = 0.814 for VOCAL and r = 0.803 for multiplanar). There was a strong correlation between embryo volume measured by the VOCAL and the multiplanar methods (ICC = 0.985, CI 95% [0.977; 0.991]). Conclusion: The VOCAL and multiplanar methods are correlated in the assessment of embryo volume in the first trimester of pregnancy.

Prenatal Diagnosis of a Fetus with Ring Chromosomal 15 by Two- and Three-Dimensional Ultrasonography

We report on a prenatal diagnosis of ring chromosome 15 in a fetus with left congenital diaphragmatic hernia (CDH) and severe intrauterine growth restriction (IUGR). A 31-year-old woman, gravida 2 para 1, was referred because of increased nuchal translucency at gestational age of 13 weeks. Comprehensive fetal ultrasound examination was performed at 19 weeks revealing an early onset IUGR, left CDH with liver herniation, and hypoplastic nasal bone. Three-dimensional ultrasound (rendering mode) showed low set ears and depressed nasal bridge. Amniocentesis was performed with a result of a 46,XX,r(15) fetus after a cytogenetic study. A 1,430 g infant (less than third percentile) was born at 36 weeks. The infant presented with respiratory failure and died at 2 h of life. Postnatal karyotype from the umbilical cord confirmed the diagnosis of 15-ring chromosome. We described the main prenatal 2D- and 3D-ultrasound findings associated with ring chromosome 15. The interest in reporting the present case is that CDH can be associated with the diagnosis of 15-ring chromosome because the critical location of the normal diaphragm development is at chromosome 15q26.1-q26.2.

P12.10: Relationship between fetal chest size and biometric parameters by three‐dimensional ultrasound using the multiplanar method

women were referred for fetal cardiac screening, the remainder for suspected abnormalities. Fetal Cardiac abnormalities were diagnosed in 16/375 (4.3%) of ‘high risk’ screened women. They included 3/61 (5%) screened women with maternal cardiac disease, 9/166 (5.4%) previous child/sibling? with CHD, 4/34 (11.8%) of screened women with diabetes mellitus. Fetal cardiac abnormalities were identified in 18/375 (4.8%) women who had multiple risk factors. There were no obvious fetal cardiac defects among screened groups with a history of paternal CHD, previous child with CHD, maternal antibodies, and history of drug intake. Conclusions: The rate of antenatally diagnosed cardiac defects is higher than expected among our screened population. However, subgroup analysis revealed that it may vary between groups. Future studies are required to evaluate the implication of implementation of routine fetal cardiac screening policy on the antenatal detection rate of CHD and its management.