Jason C. Birnholz

Human Fetal Upper Respiratory Tract Function as Revealed by Ultrasonography

The respiratory functions of the oropharynx, larynx, and trachea of normal human fetuses in utero were explored by means of realtime, two-dimensional ultrasonography combined with color-flow and spectral Doppler analysis. Coronal and transverse images revealed the maturation of coordinated respiratory activity of these structures in the late second and early third trimesters. Observation of the effects of these movements upon the flow of amniotic fluid in the fetal respiratory tract provides an appreciation of the early role of the upper airway in the modulation of fetal breathing.

Management of Infants with Prenatal Ultrasound Diagnosis of Airway Obstruction by Teratoma

We report a case of a cervical teratoma that was diagnosed prenatally. In anticipation of potential upper airway obstruction, resources were mobilized to the operating room at the time of planned cesarean section. The neonate developed respiratory distress, and her airway was secured. There was no evidence of cerebral anoxia initially, and she is currently thriving with no central or peripheral neurologic defects. As prenatal diagnosis by ultrasound becomes more refined, the otolaryngologist will play an increasing role in perinatal decision-making and anticipated emergencies at the time of delivery. Airway obstruction of various causes will be the most urgent problem.

Management of an infant with prenatal ultrasound diagnosis of upper airway obstruction

We report a case in which a cervical teratoma was diagnosed antenatally in the mid third trimester. In anticipation of potential upper airway obstruction, resources were mobilized to the operating room at the time of the planned cesarean section. The neonate was unable to breathe, but his airway was secured without delay. There was no evidence of cerebral anoxia initially or at one year follow-up. As prenatal diagnosis by ultrasound becomes more refined, the otolaryngologist will play an increasing role in perinatal decision making and anticipated emergencies at the time of delivery. Airway obstruction of various causes will be the most urgent problem.

Ultrasonic studies of human fetal brain development

Abstract The area of functional human fetal brain development is largely terra incognita for obvious technical reasons. There have been several elegant fetal anatomical studies, but these have been simple point samplings of necropsy material with a potential bias on studies of fetal or maternal—fetal conditions associated with early delivery. A large number of neuro-developmental observations have been accumulated for exteriorized fetal animals (chiefly the sheep) but it is not clear that these can be extrapolated to human development either temporally or organizationally. Finally, vast clinical progress in neonatology has enabled sequential observations of premature infants, beginning at the start of the third trimester. However, intensive-care nursery conditions are quite different from those of the intact intrauterine environment, and because of the clinical fragility of these infants and the circumstances resulting in their premature delivery, asphyxial brain injury or intracranial hemorrhage may complicate the analysis and interpretation of those data. Ultrasound imaging has provided a means of making non-invasive sequential fetal observations. This capability has been extended by technical advances that have occurred within the past two years, providing some new possibilities for monitoring CNS development.

Clinical Ultrasound Pattern Recognition

Ultrasonic imaging diagnosis has become more sophisticated as instrument performance has advanced and as the educational base of its practitioners has extended. By and large, the method is used qualitatively to answer specific medical questions, usually those involving anatomic features delineated by fluid spaces or involving local changes in tissue macrostructure. Some physiologic information is inferred from the anatomic appearance, from target dynamics, and from ancillary forms of data manipulation and display, such as the Doppler frequency shift.