M. Rousian

Reliability of three‐dimensional sonographic measurements in early pregnancy using virtual reality

To establish the reliability of three‐dimensional (3D) ultrasound measurements in early pregnancy using a virtual reality system (the Barco I‐Space).

Early pregnancy volume measurements: validation of ultrasound techniques and new perspectives

Objective  To investigate accuracy and reliability of four different ultrasound‐related volume‐measuring methods.

Gestational sac fluid volume measurements in virtual reality

To evaluate a virtual reality (VR) application for gestational sac fluid volume (GSFV) measurements in first‐trimester pregnancies and to study the correlation between different embryonic growth parameters.

Early first‐trimester trophoblast volume in pregnancies that result in live birth or miscarriage

To assess the validity of trophoblast volume measurements on three‐dimensional ultrasound (3D‐US) with Virtual Organ Computer‐aided AnaLysis (VOCALTM), to create reference values between 6 and 12 weeks of gestation and to compare trophoblast volume between pregnancies ending in miscarriage and those resulting in live birth.

Diagnostic techniques and criteria for first-trimester conjoined twin documentation: a review of the literature illustrated by three recent cases.

Objectives Conjoined twins are rare. High-quality imaging techniques are essential for proper first-trimester diagnosis. Technological development leads to new imaging techniques such as 3-dimensional virtual embryoscopy. The aim of this review was to explore imaging techniques used in the first-trimester diagnosis of conjoined twins and provide a systematic diagnostic table for making this diagnosis. Design A PubMed literature search was performed using the terms ultrasound, Doppler, MRI, and CT combined with first-trimester and conjoined twins. Three recent cases at our department are reviewed and examined additionally using 3-dimensional virtual embryoscopy. Results The different types of conjoined twins are summarized in a table for practical use during ultrasound examination. In evaluating conjoined twins, 2-dimensional ultrasound is the criterion standard. Three-dimensional and Doppler ultrasounds add anatomical and prognostic information. Virtual embryoscopy imaging reveals additional findings in our 3 cases not seen with routine 2-dimensionalultrasound examination. Conclusions Each case of conjoined twins is unique and should be evaluated with the best possible imaging techniques. Three-dimensional and Doppler ultrasound should be added to the systematic diagnostic evaluation of conjoined twins. Virtual embryoscopy imaging may contribute to earlier, more appropriate counseling and management of these pregnancies. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to differentiate between the different types of conjoined twins and their prognosis, compare the different imaging techniques used for the evaluation of conjoined twins to decide whether additional diagnostic imaging techniques are useful in an individual case, and evaluate complex cases, such as conjoined twins, using new imaging techniques.

Periconceptional maternal one-carbon biomarkers are associated with embryonic development according to the Carnegie stages

STUDY QUESTION Is periconceptional maternal one-carbon (I-C) metabolism associated with embryonic morphological development in non-malformed ongoing pregnancies? SUMMARY ANSWER Serum vitamin B12, red blood cell (RBC) folate and plasma total homocysteine (tHcy) are associated with embryonic development according to the Carnegie stages. WHAT IS KNOWN ALREADY Derangements in maternal I-C metabolism affect reproductive and pregnancy outcomes, as well as future health of the offspring. STUDY DESIGN, SIZE, DURATION Between 2010 and 2014, women with singleton ongoing pregnancies were enrolled in a prospective periconceptional cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 234 pregnancies, including 138 spontaneous or IUI pregnancies with strict pregnancy dating and 96 pregnancies derived from IVF, ICSI or cryopreserved embryo transfer (IVF/ICSI pregnancies), underwent longitudinal transvaginal three-dimensional ultrasound (3D US) scans from 6+0 up to 10+2 weeks of gestation. Carnegie stages were defined using internal and external morphologic criteria in a virtual reality system. Maternal venous blood samples were collected at enrollment for serum vitamin B12, RBC folate and plasma tHcy assessment. Associations between biomarker concentrations and longitudinal Carnegie stages were investigated using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE We performed a median of three 3D US scans per pregnancy (range 1-5) resulting in 600 good quality data sets for the Carnegie stage annotation (80.5%). Vitamin B12 was positively associated with embryonic development in the total study population (β = 0.001 (95% CI: 0.000; 0.002), P < 0.05) and in the subgroup of strictly dated spontaneous pregnancies (β = 0.002 (95% CI: 0.001; 0.003), P < 0.05). Low vitamin B12 concentrations (-2SD, 73.4 pmol/l) were associated with delayed embryonic development by 1.4 days (95% CI: 1.3-1.4) compared with high concentrations (+2SD, 563.1 pmol/l). RBC folate was positively associated with Carnegie stages only in IVF/ICSI pregnancies (β = 0.001 (95% CI: 0.0005; 0.0015), P < 0.05). In this group, low RBC folate concentrations (-2SD, 875.4 nmol/l) were associated with a 1.8-day delay (95% CI: 1.7-1.8) in development compared with high concentrations (+2SD, 2119.9 nmol/l). tHcy was negatively associated with embryonic development in the total study population (β = -0.08 (95% CI: -0.14; -0.02), P < 0.01), as well as in the IVF/ICSI subgroup (β = -0.08 (95% CI: -0.15; -0.01), P < 0.05). High tHcy concentrations (+2SD, 10.4 µmol/l) were associated with a delay of 1.6 days (95% CI: 1.5-1.7) in embryonic development compared with low concentrations (-2SD, 3.0 µmol/l). LIMITATIONS, REASONS FOR CAUTION The study was performed in a tertiary care center, resulting in high rates of folic acid supplement use and comorbidity that may reduce the external validity of our findings. WIDER IMPLICATIONS OF THE FINDINGS In periconceptional care, maternal I-C biomarkers should be taken into account as predictors of embryonic morphological development. Combining embryonic size measurements with morphological assessment could better define normal embryonic development. STUDY FUNDING/COMPETING INTEREST(S) The work was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. RPMST is CSO of the startup company Slimmere Zorg and CEO of eHealth Care Solutions. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.

Agreement and reliability of pelvic floor measurements during contraction using three‐dimensional pelvic floor ultrasound and virtual reality

Virtual reality is a novel method of visualizing ultrasound data with the perception of depth and offers possibilities for measuring non‐planar structures. The levator ani hiatus has both convex and concave aspects. The aim of this study was to compare levator ani hiatus volume measurements obtained with conventional three‐dimensional (3D) ultrasound and with a virtual reality measurement technique and to establish their reliability and agreement.

Periconceptional maternal ‘high fish and olive oil, low meat’ dietary pattern is associated with increased embryonic growth: The Rotterdam Periconceptional Cohort (Predict) Study

To investigate the association between periconceptional maternal dietary pattern and first‐trimester embryonic growth.

First-trimester detection of surface abnormalities: A comparison of 2- and 3-dimensional ultrasound and 3-dimensional virtual reality ultrasound

The aim was to determine the diagnostic performance of 3-dimensional virtual reality ultrasound (3D_VR_US) and conventional 2- and 3-dimensional ultrasound (2D/3D_US) for first-trimester detection of structural abnormalities. Forty-eight first trimester cases (gold standard available, 22 normal, 26 abnormal) were evaluated offline using both techniques by 5 experienced, blinded sonographers. In each case, we analyzed whether each organ category was correctly indicated as normal or abnormal and whether the specific diagnosis was correctly made. Sensitivity in terms of normal or abnormal was comparable for both techniques (P = .24). The general sensitivity for specific diagnoses was 62.6% using 3D_VR_US and 52.2% using 2D/3D_US (P = .075). The 3D_VR_US more often correctly diagnosed skeleton/limb malformations (36.7% vs 10%; P = .013). Mean evaluation time in 3D_VR_US was 4:24 minutes and in 2D/3D_US 2:53 minutes (P < .001). General diagnostic performance of 3D_VR_US and 2D/3D_US apparently is comparable. Malformations of skeleton and limbs are more often detected using 3D_VR_US. Evaluation time is longer in 3D_VR_US.

Virtual reality for embryonic measurements requiring depth perception

Two real-time three-dimensional images of first-trimester pregnancies visualized using virtual reality (VR) are presented. Inherently three-dimensional structures, like the umbilical cord and limbs, can be efficiently and accurately measured using VR.