Fetal imaging and diagnosis services in developing countries – A call to action

Fetal congenital anomalies are among the leading causes of perinatal death or survival with disability worldwide. Their accurate antenatal detection  employing a range of fetal imaging techniques enables parental choices to be made and for postnatal care of affected babies to be planned. While such  prenatal care is well developed in developed countries of the world, it remains poor in many low‑ and middle‑income countries (LMICs). This review article  examines the scope of the problem and proffers strategies for service  organization and fetal imaging that will improve care in LMIC settings.Key words: Congenital abnormalities; fetus; imaging; pregnancy; ultrasound

Transvaginal ultrasound during pregnancy: Perception and acceptability of Antenatal Clinic Attendees at the University College Hospital, Ibadan

Introduction: There has been a tremendous increase in the use of transvaginal ultrasound (TVS) in pregnancy. With the use of high‑resolution transducers, the transvaginal probe has proved to be particularly useful for finding the location and dating of early pregnancies when compared with transabdominal sonography (TAS). It has also been shown to be a reliable method for confirming complete miscarriage. This study aims at determining the perception and acceptability of TVS in  pregnancy.Materials and Methods: This is a descriptive cross‑sectional study of 424  consenting pregnant women attending the antenatal clinic at the University College Hospital, Ibadan. Using a self‑administered questionnaire, we obtained information on their socio‑demographic characteristics, awareness of ultrasound and TVS and opinion about TVS including acceptability and perceived complications.Results: The mean age of the respondents was 31.6 ± 4.7 years. Majority (410; 96.7%) had heard about ultrasound scanning, and 395 (93.2%) had undergone at least one type. Approximately two‑fifth (177; 41.7%) had heard about TVS, mostly from antenatal clinic, with two‑third having a good knowledge. Only 90 (21.2%) had personal experiences, and 144 (34%) believed it is harmful; however, about  three‑fifths (256; 60.4%) were willing to do TVS if indicated. Perceived  complications of TVS  included abortion, infection and bleeding. Awareness and perception were strongly associated with acceptability of TVS but not with education or previous experience.Conclusion: This study shows that the perception and acceptability of TVS by pregnant women is dependent on their level of awareness. There is an urgent need for proper information dissemination on the usefulness, safety and advantages of TVS in pregnancy.Key words: Acceptability; antenatal clinic; perception; pregnancy; transvaginal ultrasound

Late third trimester ultrasound diagnosis of duodenal atresia - the importance of detailed prenatal ultrasound screening

Duodenal atresia (DA) is the commonest type of congenital small bowel obstruction usually presenting in the neonatal period. About half of fetuses with duodenal atresia have other associated anomalies, and these associations often contribute to morbidity and mortality. DA can be fatal unless promptly diagnosed and treated surgically. In experienced hands and in countries where prenatal ultrasound screening for anomalies is routine, DA can be confidently diagnosed prenatally, which can help in reducing the perinatal morbidity and mortality associated with diagnosis after delivery.We report a case of DA diagnosed by ultrasonography at 36 weeks gestation in a 34 year old multiparous woman in a hospital where targeted prenatal ultrasound screening for fetal anomalies was recently introduced, and reviewed relevant literatureKeywords: Prenatal Ultrasound screening, Duodenal Atresi

Initial experience with 3d-ultrasound as an adjunct to 2dultrasound in fetal anomaly diagnosis in a Nigerian diagnostic facility

Introduction: Two-Dimensional ultrasound (2DUS) has been the preferred screening method for fetal abnormalities for several decades.  Three-dimensional ultrasound (3DUS) is a technique that converts standard 2D grayscale ultrasound images into a volumetric dataset which allows visualization of the fetus in all three dimensions at the same time. It provides an improved overview and a more clearly defined demonstration of adjusted anatomical planes. The use of 3D imaging is however limited to being an adjunct to 2DUS in the  visualization of fetal anomalies. The objective of this study is to highlight the importance of adding three dimensional ultrasound (3DUS) to two-dimensional ultrasound (2DUS) during fetal anomaly screening.Methodology: This is a descriptive study conducted at a private fetal diagnostic center, in Nigeria between January 2014 and December  2016. The diagnosis of fetal anomalies was first made with 2DUS after which they were evaluated with 3D ultrasound images displayed on the monitor.Results: Nine fetuses with various fetal anomalies diagnosed on 2DUS were selected for further evaluation with 3DUS. These anomalies include a neck mass, lumbar spinal abnormality, bilateral cleft lip, thanatophoric dysplasia, anencephaly, omphalocele, posterior urethral valve with anhydramnios and ambiguous genitalia diagnosed. These anomalies were better demonstrated on 3DUS.Conclusion: 2DUS remains the mainstay imaging modality in screening for fetal anomalies. However, 3DUS may complement 2DUS by allowing better delineation of anomalies and gives the parents a better visualization and understanding of identified anomalies, thereby assisting in informed decision making