S. M. Cohen

Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women.

OBJECTIVE We evaluated rate of levator ani muscle (LAM) avulsion among primiparae using 3-dimensional transperineal ultrasound to identify possible risk factors for such trauma. STUDY DESIGN We conducted a prospective observational study. Three-dimensional transperineal ultrasound was performed on all subjects. Primiparae were evaluated 24-72 hours after vaginal delivery. In all, 32 nulliparous gravidae (35-41 weeks) and 15 elective cesarean delivery primiparae were evaluated as methodological controls. We compared newborn head circumference (HC), birthweight, second stage duration, maternal age, baby sex, episiotomy, and instrumental delivery. RESULTS LAM trauma was observed in 39 of 210 (18.8%) patients and no controls. Odds ratio for LAM trauma when newborn HC >or= 35.5 cm was 3.343 (95% confidence interval, 1.33-8.42); when second stage duration >or= 110 minutes, odds ratio was 2.27 (95% confidence interval, 1.07-4.81). Logistic regression showed that HC >or= 35.5 and second stage duration >or= 110 minutes increased odds of LAM trauma by a factor of 5.32. CONCLUSION Large HC and prolonged second stage duration are risk factors in LAM trauma. Elective cesarean delivery may prevent LAM trauma.

3D and 4D ultrasound in fetal cardiac scanning: a new look at the fetal heart

Over the last decade we have been witness to a burgeoning literature on three‐dimensional (3D) and four‐dimensional (4D) ultrasound‐based studies of the fetal cardiovascular system. Recent advances in the technology of 3D/4D ultrasound systems allow almost real‐time 3D/4D fetal heart scans. It appears that 3D/4D ultrasound in fetal echocardiography may make a significant contribution to interdisciplinary management team consultation, health delivery systems, parental counseling, and professional training.

Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode

Quantification of fetal heart ventricle volume can aid in the evaluation of functional and anatomical aspects of congenital heart disease. The aim of this study was to establish nomograms for ventricular volume using three‐dimensional (3D) inversion mode ultrasonography with the spatio‐temporal image correlation (STIC) modality and to calculate ejection fraction and stroke volume.

The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise.

The human fetal venous system is well‐recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise. Copyright

Added value of three-/four-dimensional ultrasound in offline analysis and diagnosis of congenital heart disease.

Many published studies have shown that application of three‐dimensional (3D) and real‐time 3D (4D) ultrasound modalities can improve certain aspects of fetal echocardiography, but have left open the question of whether these modalities improved the accuracy of prenatal detection of anatomical fetal cardiovascular malformations. We aimed to determine whether 3D/4D ultrasound improved diagnostic ability in cases of congenital heart disease (CHD).

Functional assessment of the fetal heart: a review

The purpose of this review is to evaluate the current modalities available for the assessment of fetal cardiac function. The unique anatomy and physiology of the fetal circulation are described, with reference to the difference between @ in‐utero and @ ex‐utero life. M‐mode, early/atrial ratio, myocardial performance index, three‐dimensional and four‐dimensional ultrasound, tissue Doppler including strain and strain rate, speckle tracking, magnetic resonance imaging and venous flow assessment are described. The modalities are analyzed from the perspective of the clinician and certain questions are posed. Does the modality assess systolic function, diastolic function or both? Is it applicable to both ventricles? Does it require extensive post‐processing or additional hardware, or does it make use of technology already available to the average practitioner? The reproducibility and reliability of the techniques are evaluated, with reference to their utility in clinical decision‐making. Finally, directions for future research are proposed. Copyright

The fetal venous system, Part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation

Since its introduction in the mid‐1980s sonographic evaluation of the human fetal venous system has advanced dramatically. The venous system is well‐recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. Appreciation of the normal embryology, anatomy and physiology of this system is essential to an understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction or other developmental disorders. We review the normal embryology, anatomy, and hemodynamics of the human fetal venous system, and provide an overview of Doppler investigation, as well as three‐ and four‐dimensional ultrasound modalities and their application to this system. Copyright

Fetal Cardiology: Embryology, Genetics, Physiology, Echocardiographic Evaluation, Diagnosis and erinatal Management of Cardiac Diseases

Cardiovascular Development. Cardiac Morphogenesis. Cardiac Anatomy and Examination of Specimens. Placental Implantation and Development. Placental Circulations. The Physics of Ultrasound Imaging. Epidemiology of Congenital Heart Disease: Etiology,Pathogenesis and Incidence. Indication for Fetal Echocardiography: Screening in Low- and High-Risk Populations. Fetal Circulation. Development of Fetal Cardiac and Extracardiac Doppler Flows in Early Gestation. The Examination of the Normal Fetal HeartUsing Two-Dimensional Echocardiography. Early Human Fetal Cardiovascular Dynamics. First and Early Second Trimester Fetal Heart Screening. Three Dimensional Fetal Echocardiography. Cardiac Malpositions and Syndromes with Right or Left Atrial Isomerism.Anomalies of the Right Heart. Intracardiac Shunt Malformations. Left Heart Malformations. Ventricular Outflow Tract Anomalies. Truncus Arteriosus or Common Atrial Trunk. Fetal Detection of Arterial Malpositions. Abnormal Visceral and Atrial Situs andCongenital Heart Disease. Diseases of the Myocardium, Endocardium and Pericardium During Fetal Life. Cardiomyopathy in the Fetus. Examination of the Fetal Coronary Circulation. Fetal Cardiac Tumors. The Fetal Venous System: Normal Embryology, Anatomy andPhysiology and the Development and Appearance of Anomalies. Diagnosis of Cardiac Arrhythmias During Fetal Life. Fetal Bradydysrhythmia. Fetal Tachyarrhythmia. Cardiac Diseases in Association with Hydrops Fetalis. Genetics and Cardiac Abnormalities.Cardiac Defects in Chromosomally Abnormal Fetuses. Associated Anomalies in Congenital Heart Disease. From Fetal to Neonatal Circulation. The Neonate with Congenital Heart Disease - Medical and Interventional Management. Infants with Congenital HeartDisease in the First Year of Life. Prospects for Fetal Cardiac Surgery. Saving the Smallest Hearts - Cardiac Intervention for Structural Heart Disease and Arryhthymias in the Fetus. Fetal Cardiac Function in Normal and Growth-Restricted Fetuses. VenousFlow in Intrauterine Growth Restriction and Cardiac Decompensation. Fetal Distress and Intrapartum Monitoring. Cardiac Disease in Pregnancy. Maternal Diseases and Therapies Affecting the Fetal Cardiovascular System.

Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis

Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome.

Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion.

Adnexal torsion is a common gynecologic emergency affecting females of all ages. Expedient diagnosis and treatment are important, particularly in young fertile patients to preserve ovarian viability. Classical parameters for the clinical and sonographic diagnosis of adnexal torsion have very high false‐positive rates, approaching 50%. The sonographic ‘whirlpool’ sign has been shown to be effective for visualizing the torsed part in the prenatal diagnosis of malrotation of the midgut with volvulus, as well as scrotal and ovarian torsion. We aimed to evaluate the efficacy of the whirlpool sign in the diagnosis of torsion, as compared to a protocol based on ‘classic’ sonographic signs of torsion alone.