Liat Gindes

Collaborative study on 4-dimensional echocardiography for the diagnosis of fetal heart defects: The COFEHD study

Objective. Congenital anomalies are the leading cause of infant mortality in the United States, and congenital heart defects (CHDs) are the most common type of birth defects. Recently, 4‐dimensional ultrasonography (4DUS) with spatiotemporal image correlation (STIC) has been introduced for fetal echocardiography. Accumulating evidence indicates that 4DUS with STIC may facilitate the examination of the fetal heart. Our objectives were to determine the accuracy of 4DUS for the diagnosis of CHDs and the agreement among centers. Methods. This study included 7 centers with expertise in 4D fetal echocardiography. Fetuses with and without confirmed heart defects were scanned between 18 and 26 weeks, and their volume data sets were uploaded onto a centralized file transfer protocol server. Intercenter agreement was determined using a κ statistic for multiple raters. Results. Ninety volume data sets were randomly selected for blinded analysis. Overall, the median (range) sensitivity, specificity, positive and negative predictive values, and false‐positive and ‐negative rates for the identification of fetuses with CHDs were 93% (77%–100%), 96% (84%–100%), 96% (83%–100%), 93% (79%–100%), 4.8% (2.7%–25%), and 6.8% (5%–22%), respectively. The most frequent CHDs were conotruncal anomalies (36%). There was excellent intercenter agreement (κ = 0.97). Conclusions. (1) Four‐dimensional volume data sets can be remotely acquired and accurately interpreted by different centers. (2) Among centers with technical expertise, 4DUS is an accurate and reliable method for fetal echocardiography.

Three and four dimensional ultrasound: a novel method for evaluating fetal cardiac anomalies

To evaluate the role of various new models of 3‐ and 4‐dimensional (3D and 4D) ultrasound (US) applications in prenatal assessment of fetal cardiac anomalies.

In-utero evaluation of the fetal umbilical–portal venous system: two- and three-dimensional ultrasonic study

To describe the normal anatomy of the fetal umbilical–portal venous system (UPVS) and to assess possible anatomical variants of the main portal vein (MPV) insertion into the portal sinus (PS).

Prenatal diagnosis of congenital agenesis of the fetal portal venous system

To describe the prenatal diagnosis and review our experience of fetal congenital agenesis of the portal venous system (CAPVS) and to review the current literature on this poorly documented vascular malformation.

Three‐ and four‐dimensional ultrasound: new methods for evaluating fetal thoracic anomalies

To study three‐ (3D) and four‐dimensional (4D) ultrasound applications for the evaluation of fetal thoracic anomalies.

Vermian Biometric Parameters in the Normal and Abnormal Fetal Posterior Fossa Three-Dimensional Sonographic Study

The purposes of this study were to describe a 3‐dimensional sonographic technique for evaluation of the fetal vermis and to compare vermian biometric parameters in fetuses with a normal and an abnormal posterior fossa.

Isolated levocardia: prenatal diagnosis, clinical importance, and literature review.

Isolated levocardia is a rare type of situs inversus in which the heart is in the normal levo position, but the abdominal viscera are in the dextro position. We aim to describe our experience with prenatal diagnosis and management in fetuses with isolated levocardia.

Perinatal outcome of monochorionic twins with selective IUGR compared with uncomplicated monochorionic twins

OBJECTIVE To evaluate the perinatal outcome of MC twins with selective IUGR (sIUGR). STUDY DESIGN A prospective study, which included three groups of MC twins: Group A, uncomplicated MC twin pregnancies (n = 91); group B, sIUGR with normal umbilical artery Doppler (n = 19); and group C, sIUGR with abnormal (absence or reversed EDV) umbilical artery Doppler (n = 18). The latter were routinely hospitalized in the high-risk ward under strict surveillance. RESULTS Neonatal outcome of fetuses complicated with sIUGR and normal Doppler was similar to controls. Neonates born to pregnancies complicated by sIUGR and abnormal Doppler had significantly increased incidence of CNS findings, RDS, NEC, sepsis, and neonatal death compared to controls. Adverse outcome in this group was independently associated only with gestational age at birth. CONCLUSION The perinatal outcomes of MC twins complicated with sIUGR and normal Doppler are similar to uncomplicated MC pregnancies. MC twins with sIUGR and abnormal Doppler have reasonable outcomes, yet significantly more neonatal complications compared to non-complicated MC twins.

Evaluation of the Fetal Secondary Palate by 3-Dimensional Ultrasonography

Objective. Diagnosis of cleft lip and palate remains a challenge with 2‐dimensional ultrasonography, particularly when clefting involves only the secondary palate. The utility of 3‐dimensional ultrasonography (3DUS) has enhanced our ability to detect clefts. We report our experience with a modification of the flipped face technique to aid in the diagnosis of clefting of the secondary palate. Methods. Ninety‐two volumes of 92 fetal faces were evaluated. Thirty‐six volumes were acquired prospectively. Fifty‐six volumes had previously been acquired and included 8 with clefting of the secondary palate. Volumes were obtained on 3DUS systems and reviewed by 4 blinded readers on personal computer workstations. Volumes were manipulated so that an upright profile was visualized. The palate was then rendered using a thin, curved render box. Statistical analysis was performed using the Fisher exact test for categorical data. Intraclass correlations were computed to assess inter‐rater agreement. Results. The mean gestational age at image acquisition ± SD was 22 ± 5 weeks. Image quality of the secondary palate was obtained and rated as adequate by at least 2 reviewers in 34% (31 of 92) of volumes. The sensitivity of cleft detection ranged from 33% to 63%, and the specificity ranged from 84% to 95%. The low sensitivity was mainly due to artifacts/shadowing. The inter‐rater reliability was 0.62 (95% confidence interval, 0.47–0.76). Conclusions. Three‐dimensional ultrasonography can be used to diagnose clefts of the secondary palate. This evaluation is limited by the fetal position and artifacts from shadowing of adjoining structures. Pseudoclefts can be created, and optimal imaging cannot be obtained in all fetuses.

Umbilical vein anomaly in fetuses with Down syndrome

To describe the prevalence of abnormal umbilical vein (UV) anatomy in fetuses with Down syndrome.