R. Ruano

Three‐dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia

Objectiveu2003 To evaluate the potential of three‐dimensional ultrasound to predict outcome in congenital diaphragmatic hernia.

Accuracy of fetal lung volume assessed by three-dimensional sonography

To determine the accuracy and precision of prenatal three‐dimensional (3D) ultrasound in estimating fetal lung volume using the rotational multiplanar technique (VOCAL™) by comparing it to postmortem volume measurements.

A nomogram of fetal lung volumes estimated by 3-dimensional ultrasonography using the rotational technique (virtual organ computer-aided analysis).

Objective. The purpose of this study was to build a nomogram of normal fetal lung volumes throughout gestational age estimated by 3‐dimensional ultrasonography using the rotational technique (Virtual Organ Computer‐Aided Analysis [VOCAL]; GE Healthcare, Kretztechnik, Zipf, Austria). Methods. Fetal lung volume was assessed in 146 healthy fetuses by 3‐dimensional ultrasonography using the technique of rotation of the multiplanar imaging (VOCAL). Inclusion criteria were healthy women with singleton normal pregnancies, normal fetal morphologic ultrasonographic findings, reliable dating established by dates and by ultrasonographic measurement of the crown‐lump length in the first trimester, and gestational age from 20 to 37 weeks. Exclusion criteria were discordance between clinical and ultrasonographic dating, patients lost to follow‐up, and birth weight disorders. Each patient was scanned once during pregnancy. Results. The right, left, and total mean pulmonary volumes ranged, respectively, from 5.37, 4.66, and 9.95 cm3 at 20 weeks to 46.06, 37.34, and 84.35 cm3 at 37 weeks. The logistic transformation analysis yielded the following formulas: right lung volume = exp(4.07/[1 + exp(21.90 − gestational age/5.44)]); left lung volume = exp(3.82/(1 + exp[22.03 − gestational age/5.17)]); and, total lung volume = exp(4.72/[1 + exp(20.30 − gestational age/6.05)]). Conclusions. A new nomogram of fetal lung (right, left, and total) volumes throughout gestational age using the rotational technique (VOCAL) is described, and reference values have been generated.

Comparison of fetal lung area to head circumference ratio with lung volume in the prediction of postnatal outcome in diaphragmatic hernia.

To compare prediction of postnatal survival in isolated diaphragmatic hernia by prenatal two‐dimensional (2D) versus three‐dimensional (3D) sonographic assessment of the contralateral lung.

Prenatal diagnosis of pulmonary sequestration using three-dimensional power Doppler ultrasound

To investigate the contribution of three‐dimensional power Doppler ultrasound to the prenatal diagnosis of pulmonary sequestration.

Predicting perinatal outcome in isolated congenital diaphragmatic hernia using fetal pulmonary artery diameters

OBJECTIVEnThe aim of the study was to evaluate the potential of fetal pulmonary artery (PA) diameters to predict perinatal death and pulmonary arterial hypertension (PAH) in congenital diaphragmatic hernia (CDH).nnnSTUDY DESIGNnIn this prospective observational study, observed PA (main, right, and left) diameters were measured at the level of the 3 vessels in 21 fetuses with isolated CDH and in 85 controls at 22 to 36 weeks. The observed/expected (o/e) diameters of the main, contralateral, and ipsilateral PAs were calculated by comparing these measurements with reference values obtained in our previous study and correlated with perinatal death and postnatal PAH.nnnRESULTSnThe o/e PA diameters were significantly reduced in fetuses with CDH compared to controls (P < .001) and in fetuses with CDH who died (P < .050). However, there was no significant association between PA diameters and PAH (P >or= .050).nnnCONCLUSIONSnThe PA diameters might be useful to predict perinatal death in isolated CDH but not postnatal PAH, suggesting that PA diameters are probably related to the severity of pulmonary hypoplasia.

Second- and Third-Trimester Therapeutic Terminations of Pregnancy in Cases with Complete Placenta previa – Does Feticide Decrease Postdelivery Maternal Hemorrhage?

Objective: To study the feasibility of second- and third-trimester termination of pregnancy (TOP) with complete placenta previa, and the impact of performing feticide before labor induction on maternal hemorrhagic morbidity. Patients and Methods: From 1987 to 2002, the databases of two referral hospitals were reviewed. We identified 15 cases of second- or third-trimester TOP in women with complete placenta previa. Feticide was performed 2–14 days before induction in 6/15 cases. Cervical ripening was achieved in 8 cases by mifepristone alone (n = 2) or by mifepristone and dilapan (n = 6). Labor was induced by vaginal gemeprost (n = 2), intramuscular (n = 5) or intravenous (n = 4) sulprostone, vaginal misoprostol (n = 1) or a combination of misoprostol and sulprostone (n = 3). Hemorrhage was defined by the need for transfusion. The difference between the preoperative and the lowest per- or postoperative maternal hemoglobin level was also analyzed. Results: Of the 9 women who underwent labor induction without previous feticide, 4 required blood transfusions, 1 of whom had a hemostat hysterectomy. The mean hemoglobin difference was 2.5 g/dl (range: 0.5–5.3). None of the 6 patients with preinduction feticide required transfusion. The hemoglobin difference was significantly smaller in this group than in terminations without previous feticide (mean: 1.0 g/dl ; range: 0.1–2.2; p = 0.03). Conclusion: In cases with complete placenta previa, second- or third-trimester TOP is feasible. It carries a substantial risk of hemorrhage that might be decreased by preinduction feticide.

Three-dimensional ultrasonographic measurements of the fetal lungs for prediction of perinatal outcome in isolated congenital diaphragmatic hernia

Aim:u2002 To evaluate the potential of different lung measurements using three‐dimensional ultrasonography (3D‐US) to predict perinatal outcome in isolated congenital diaphragmatic hernia (CDH).

Predicting pulmonary hypoplasia using the sonographic fetal lung volume to body weight ratio — how precise and accurate is it?

To determine the precision and accuracy of ultrasound in estimating the fetal lung to body weight ratio (FLB ratio) using two‐dimensional (2D) and three‐dimensional (3D) ultrasound by comparison with postmortem measurements, and to evaluate its potential to diagnose pulmonary hypoplasia.

Ipsilateral Lung Volumes Assessed by Three-Dimensional Ultrasonography in Fetuses with Isolated Congenital Diaphragmatic Hernia

Objective: To evaluate the precision of three-dimensional ultrasonography (3DUS) in estimating the ipsilateral lung volume and the potential of this measurement to predict neonatal death in congenital diaphragmatic hernia (CDH). Methods: Between January 2002 and December 2004, the ipsilateral lung volumes were assessed by 3DUS using the technique of rotation of the multiplan imaging in 39 fetuses with CDH. The observed/expected ipsilateral lung volume ratios (o/e-IpsiFLVR) were compared to the lung/head ratios (LHR) and to the observed/expected total fetal lung volume ratios (o/e-TotFLVR) as well as to postnatal death. Results: Ipsilateral lung volumes (median 0.12, range 0.01–0.66) were more reduced than the total lung volumes (median 0.52, range 0.11–0.95, p < 0.001) in CDH. The bias and precision of 3DUS in estimating ipsilateral lung volumes were –0.61 and 0.99 cm3, respectively, with absolute limits of agreement from –2.56 to +1.33 cm3. The o/e-IpsiFLVR was lower in neonatal death cases (median 0.09, range 0.01–0.46) than in survivals (median 0.18, range 0.01–0.66), but this difference was not statistically significance (p > 0.05). The sensitivity, specificity, (positive and negative) predictive values and accuracy of o/e-IpsiFLVR in predicting neonatal death was 52.6% (10/19), 83.3% (10/12), 83.3% (10/12), 52.6% (10/19) and 64.5% (20/31), respectively. Conclusion: Although the ipsilateral lung volume can be measured by 3DUS, it cannot be used to predict neonatal death when considering it alone. However, it is important to measure it to calculate the total fetal lung volumes as the o/e-TotFLVR has the best efficacy in predicting neonatal death in isolated CDH.