Moshe Bronshtein

First-trimester and early second-trimester diagnosis of nuchal cystic hygroma by transvaginal sonography: Diverse prognosis of the septated from the nonseptated lesion

Fetal cystic hygroma is a congenital malformation of the lymphatic system appearing as a single or multiloculated fluid-filled cavity, most often in the nuchal region. The malformation is believed to arise from failure of the lymphatic system to communicate with the venous nuchal system. Sometimes the lesion progresses to fetal hydrops, causing fetal death. To further delineate the cause and natural history of this disorder, we have prospectively studied eight cases of cystic hygroma of the neck, detected at gestational ages of 9 to 15 weeks by transvaginal sonography. Three of the eight fetuses survived (37.5%) and were normal at birth. Either hydrops fetalis or intrauterine fetal death occurred in the other five fetuses. In one of these five, therapeutic abortion was induced because of trisomy 21. In another fetus of these five, trisomy 18 was diagnosed by amniocentesis. This pregnancy ended in intrauterine fetal death. The ultrasonic evaluation of the cystic hygromas revealed that those that were reabsorbed in the three ultimately normal viable fetuses were nonseptated cysts, whereas all the four cystic hygromas ending in fetal death or associated with aneuploidy were septated, multilocular hygromas. In another fetus with nonseptated hygroma, nonimmune hydrops developed, which resulted in premature delivery and early neonatal death.

Sonographic measurements of the umbilical cord and vessels during normal pregnancies

Sonographic measurements of the umbilical cord and vessels were performed in 368 uncomplicated pregnancies, and nomograms of their growth were constructed. All measurements were obtained in appropriate for gestational age fetuses in pregnancies with accurate dating. From the above measurements, an estimate of Whartons jelly quantity (expressed as square millimeters) was calculated. The nomograms presented add another biometric measurement of normally growing fetuses and may serve to differentiate between them and those who are found to have umbilical cord abnormalities.

The Early Prenatal Diagnosis of Cleft Lip and the Decision–Making Process

In 1996, Bronshtein et al. published an article entitled “Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft lip” in the British Journal of Oral and M...

Spontaneous fetal reduction in multiple gestations assessed by transvaginal ultrasound

Objective To assess the occurrence of disappearance of one or more of the fetuses in pregnancies which start as multiple gestation.

Hemorrhagic ovarian cyst detection by transvaginal sonography: The great imitator

The sonograms of 102 hemorrhagic ovarian cysts (HOC) were reviewed to ascertain the full spectrum of sonographic findings as visualized by transvaginal sonography (TVS). The diagnoses, in 11 cases, were proven by surgery and the rest have undergone conservative follow-up until resolution (clinically and sonographically). The accurate diagnosis of HOCs by transabdominal sonography is quite difficult. The appearance of these cysts as visualized by TVS is described. We advise TVS as a better means for identification of HOCs, thus decreasing the rate of diagnostic invasive procedures.

NATURAL HISTORY OF FETAL SIMPLE RENAL CYSTS DETECTED IN EARLY PREGNANCY

PURPOSE In this 12-year prospective, longitudinal study we investigated the natural history of fetal simple renal cysts identified by ultrasonography in early pregnancy. MATERIALS AND METHOD A detailed sonographic examination of the fetus was performed between January 1987 and June 1998 in 29,984 consecutive pregnancies at 14 to 16 weeks of gestation. Amniocenteses and chromosomal investigations were done in all cases in which a simple renal cyst was detected in the fetus. Followup sonography was done in all cases of renal cyst during pregnancy, infancy and, when indicated, childhood. RESULTS Simple renal cysts were diagnosed at 14 to 16 weeks of gestation in 28 fetuses (1/1,100 pregnancies, 0.09%). In 25 fetuses the cysts resolved during pregnancy. In 2 fetuses the cysts remained benign but persisted postnatally and in 1 a renal cyst that was initially defined as simple was the first sign of unilateral multicystic dysplastic kidney. Except for nonseptated cystic hygroma in 1 fetus, none of the others had associated anomalies of the urinary or other organ systems and no chromosomal anomalies. Postnatal followup in all cases revealed healthy children. CONCLUSIONS A fetal simple renal cyst can be identified by ultrasonography in early pregnancy. In the absence of associated anatomical or chromosomal abnormalities, the majority of cysts will resolve during pregnancy without any sequelae. Given the transient nature of most fetal simple renal cysts detected in early pregnancy, it is possible that these cysts represent a distinct entity within the spectrum of cystic kidney diseases.

Sonographic imaging of cervical scars after Cesarean section

To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar.

The influence of prenatal ultrasound on the prevalence of congenital anomalies at birth

The objectives of the study were (1) to assess whether prenatal ultrasound examinations affected the prevalence of congenital anomalies at birth and the incidence of terminations of pregnancy for fetal anomalies and (2) to examine the detection rate of the main fetal anomalies. We studied all births and stillbirths with congenital defects, and all terminations of pregnancy for fetal anomalies in the Rambam Medical Center during a 5‐year period (1989–1993) and correlated them to ultrasound findings. There were 23 439 births during the study period. The incidence of newborns with anomalies decreased from 1·95 to 1·34 per cent (P < 0·01). The incidence of termination of pregnancy because of fetal anomalies increased from 0·35 to 0·83 per cent (P < 0·003) and the detection rate of malformations increased from 53·94 to 79·60 per cent (P < 0·001). It is concluded that terminations of pregnancy after ultrasound detection of fetal anomalies had an impact on the prevalence of anomalies in newborns. There was also continuing significant improvement in the detection rate of ultrasound examinations.

The utility of detailed first trimester ultrasound examination in abnormal fetal nuchal translucency

To determine the value of a first trimester fetal ultrasound examination in cases of an increased nuchal translucency (NT).

Prenatal sonographic diagnosis of vermal agenesis

Agenesis of the vermis as detected during gestation by ultrasonography may indicate the existence of various malformation arrays or syndromes. We report on our observations of five cases of complete vermal agenesis that were detected at 22–31 weeks of gestation. All had a vertex presentation and transvaginal sonography established the diagnosis of vermal agenesis. Two of the vermal agenesis cases had no associated anomalies outside the central nervous system (CNS). In one, the cerebellar cleft was the only abnormality present and the other also had lobar holoprosencephaly. The three remaining fetuses had trisomy 13 and featured various additional extra‐CNS anomalies. The association of complete vermal agenesis and trisomy 13 has not been previously reported. Our experience with this series suggests that supplementation with vaginal fetal sonography is a valuable tool for obtaining a more accurate view of the posterior fossa whenever a cyst or a cyst‐like abnormality is detected by transabdominal sonography. A finding of isolated vermal agenesis appears to mandate a careful search for additional anomalies and the performance of karyotype analysis.