Michal Zajicek

Three‐dimensional ultrasound demonstration of the fetal palate in high‐risk patients: the accuracy of prenatal visualization

The aim of this research was to evaluate the ability of three‐dimensional (3D) ultrasound for demonstrating the palate of fetuses at high risk for cleft palate.

Direct Feeding at the Breast Is Associated with Breast Milk Feeding Duration among Preterm Infants

Background: In spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge. Aim: To investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants. Methods: The study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants’ computerized charts. Mothers were approached >12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast. Results: Out of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF ≥ 6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00–15.37; OR 1.5 and 95% CI 1.25–1.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation <6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons. Conclusions: Direct feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born <32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants.

Prenatal diagnosis of obstructive hydrocephalus associated with parvovirus B19 infection.

BACKGROUND: Intrauterine parvovirus B19 infection is a well-known cause for hydrops fetalis and fetal demise. We present a case of isolated fetal obstructive hydrocephalus caused by an intrauterine parvovirus B19 infection. CASE: A 23-year-old woman, gravida 3 para 2, was referred for fetal obstructive hydrocephalus. Although there were no signs of fetal anemia, increased maternal parvovirus B19-specific immunoglobulin G and immunoglobulin M raised the suspicion of fetal infection. This was confirmed by polymerase chain reaction in the amniotic fluid. Elective cesarean delivery was performed at 34 weeks of gestation, followed by craniotomy and placement of shunt. At the age of 20 months, the childs development was in accordance with his age, with the exception of gross motor function, which was moderately delayed. CONCLUSION: Evaluation of fetal obstructive hydrocephalus should include maternal serological tests for parvovirus B19.

Feasibility of Detection of the 3-Vessel and Trachea View Using 3-Dimensional Sonographic Volumes

The purpose of this study was to investigate the ability to depict the 4‐chamber and 3‐vessel and trachea views of the fetal heart using 3‐dimensional sonography.

Outcome of twin pregnancies complicated by early second trimester rupture of membranes in one sac.

The aim of this study was to present the outcome of bichorionic twin pregnancies complicated by early second trimester rupture of membranes in one sac. Data regarding all cases of ruptured membranes at 13-20 weeks in bichorionic twin pregnancies were collected retrospectively from three fetal medicine units. Patients who have chosen to terminate the pregnancy were excluded from the study. Between January 2003 and July 2009, nine patients met inclusion criteria. Three out of nine couples decided on expectant management, and six preferred selective feticide. With expectant management one fetus died in utero and take home baby rate was 83% (5 of 6 fetuses), delivered at 27-32 weeks. When selective termination was performed, all non-reduced fetuses were born alive at 33-40 weeks. Two survivors of rupture of membranes had limb contractures, none had lung hypoplasia. One patient had clinical signs of amnionitis, which was ruled out later on pathological examination. Her post partum course was uncomplicated. Our data suggest that rupture of membranes in one sac of bichorionic twins at 13-20 weeks has favorable prognosis whether an intervention is preformed or not. Nonetheless, selective termination may have an advantage over expectant management, since gestational age at delivery was higher when selective termination was performed.

Identification of the Fetal Hippocampus and Fornix and Role of 3-Dimensional Sonography

The purposes of this study were to identify the fetal hippocampus and fornix using 3‐dimensional sonography, to measure their curved length during pregnancy, and to describe a systematic method for volume data set analysis of the fetal hippocampus and fornix.

Crossed ectopic kidney: prenatal diagnosis and postnatal follow‐up

The objective of this study is to investigate prenatal diagnosis and postnatal outcome of fetuses with crossed ectopic kidney.

Advanced Topics on Three-dimensional Ultrasound in Obstetrics and Gynecology

It is important to know how three-dimensional ultrasound (3DUS) works and its functions for making the best use of 3DUS. 3DUS shows various kinds of images through following processes: 1. Acquisition of 3D data (3D scanning) A large number of consecutive tomographic (2D) images are obtained through 3D scanning with a 3D probe; 2. Construction of a 3D data set A 3D data set is constructed from the acquired 2D images. A gated technique called STIC (spatiotemporal image correlation) is used for construction of 3D data sets of the fetal heart; 3. Volume visualization A computer constructs 2D and 3D images from the 3D data set. 3DUS shows multiplanar images, such as a multi-parallel-plane image and a three-orthogonal-plane image. Each plane can be selected arbitrarily by translation and rotation of the 3D data set. Most of 3D images are constructed by volume rendering. Proper settings of ROI (region of interest) and threshold are important for obtaining a clear surface rendered image. Electrical scalpel (or “MagiCut”) is used to eliminate unfavorable structures around the object. Various kinds of 3D images as well as a surface rendered image can be obtained by volume rendering. Surface rendering is also used for 3D image construction. Boundaries of the object should be outlined strictly and it takes a lot of time to get a 3D image in surface rendering. But once the object is extracted, the volume of the object can be calculated.

P08.03: Detection of the ‘3VT view’ using 3D ultrasound volumes acquired at the level of the ‘4CV’

Objectives: The four-chamber view (4CV) detects about 30% of major cardiac anomalies. Adding the outflow tract and the three-vessel trachea view (3VT) improve the detection of cardiac anomalies. 3-Dimensional ultrasound (3DUS) is more available than 4-Dimensional ultrasound for cardiac examinations. The aim of this study is to investigate the ability to demonstration of the 3VT of the fetal heart with 3DUS, and to test the reliability of the measurements of the arches. Methods: Prospective study of normal fetal heart volumes, acquired at the second trimester of gestation by 3DUS with color Doppler. Post processing off line manipulation of the volumes to demonstrate the 3VT view by two expert sonologists. The ‘V’ shape of the arches, the color of flow and the place of the trachea and superior vena cava were evaluated. Measurements of the aorticand ductal-arch diameter were calculated and compared to the value from literature of 2-Dimension ultrasound. Intraand inter-observer variability was calculated. Results: 31 healthy patients with normal fetuses by anomaly scan were evaluated prospectively. Mean gestational age was 22w6d (range 19w4d–25w0d). Navigation in the cephalic direction revealed the 3VT view in 87–90% by the two reviewers. Mean and 95CI diameter of the aortic and pulmonary arteries are presented in Table 1. The estimated time for volume acquisition and manipulation in the A plane is about 60 seconds. Conclusions: Combination of basic knowledge of 3DUS and demonstration of 4CV allows extension of the cardiac examination to the 3VT view in about 90% of cases. Information of the number of vessels, shape, diameter, flow direction and the relation of the two arches is collected with simple sonographic method.

OC24.04: 3‐dimensional ultrasound demonstration of fetal anal canal and sphincter

13.53◦ (95% CI: 13.28◦–13.78◦, 5th–95th percentile: 10.4◦–16.9◦). In 22 fetuses with facial clefts (median gestational age: 23 weeks, range: 19+1–29+6 weeks) the mean MNM was 20.6◦ (95% CI: 18.2◦–23.0◦). In all fetuses (n = 3) with intact alveolar ridge the MNM angle was normal. In 13 fetuses with unilateral interruption of the alveolar ridge the MNM angle was above the 95th percentile in 62% (n = 8) and normal in 38% (n = 5) of the cases. In all (n = 6) fetuses with bilateral interruption of the alveolar ridge the MNM angle was above the 95th percentile. Conclusions: The MNM angle can quantify the amount of maxillary protrusion in fetuses with facial clefts. A MNM angle above the 95th percentile indicates an (at least unilateral) interruption of the alveolar ridge.