A new approach to fetal echocardiography: digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease

OBJECTIVE: The purpose of this study was to describe a method of 4-dimensional (4D) reconstruction of the cardiac chambers and outflow tracts using a combination of spatiotemporal image correlation, "inversion mode," and "B-flow" imaging. METHODS: Spatiotemporal image correlation and the inversion mode were used in the examination of the volume data sets of 23 fetuses with congenital heart anomalies. A subset was also examined with B-flow imaging using the gradient light algorithm. Digital reconstructions from abnormal hearts were compared with a library obtained from fetuses without abnormalities. RESULTS: Rendered images of the 4-chamber view using the inversion mode were characterized by: (1) echogenic chambers; (2) sharp delineation of chamber contours when compared with 2-dimensional (2D) images; and (3) distinct display of the myocardium, interventricular septum, interatrial septum, and mitral and tricuspid valves as anechoic structures. Ventricular septal defects, abnormal differential insertion of the atrioventricular valves, and valve atresia were well visualized with the inversion mode. The application of inversion mode or B-flow imaging to 4D rendering of the outflow tracts resulted in "digital casts" displaying the spatial relationships between the outflow tracts as well as the connections between the great arteries and ventricular chambers. The spatial relationships and communications among cardiac structures cannot be visualized with conventional 2D ultrasonography. CONCLUSIONS: The application of spatiotemporal image correlation, inversion mode, and B-flow imaging generates information about the anatomy and pathologic characteristics of the fetal heart (digital casts) that cannot be obtained with 2D fetal echocardiography. We propose that these modalities enhance the information provided by ultrasonographic interrogation of the fetal heart and will improve prenatal diagnosis

Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis

BACKGROUND: Fetal macrosomia is associated with an increased risk of adverse maternal and neonatal outcomes. OBJECTIVES: To compare the accuracy of antenatal two-dimensional (2D) ultrasound, three-dimensional (3D) ultrasound, and magnetic resonance imaging (MRI) in predicting fetal macrosomia at birth. SEARCH STRATEGY: Medline (1966-2013), Embase, the Cochrane Library and Web of Knowledge. SELECTION CRITERIA: Cohort or diagnostic accuracy studies of women with a singleton pregnancy, who had third-trimester imaging to predict macrosomia (>4000 g, >4500 g or >90th or >95th centile). DATA COLLECTION AND ANALYSIS: Two reviewers screened studies, performed data extraction and assessed methodological quality. The bivariate model was used to obtain summary sensitivities, specificities and likelihood ratios. MAIN RESULTS: Fifty-eight studies (34 367 pregnant women) were included. Most were poorly reported. Only one study assessed 3D ultrasound volumetry. For predicting birthweight >4000 g or >90th centile, the summary sensitivity for 2D ultrasound (Hadlock) estimated fetal weight (EFW) >90th centile or >4000 g (29 studies) was 0.56 (95% CI 0.49-0.61), 2D ultrasound abdominal circumference (AC) >35 cm (four studies) was 0.80 (95% confidence interval [95% CI] 0.69-0.87) and MRI EFW (three studies) was 0.93 (95% CI 0.76-0.98). The summary specificities were 0.92 (95% CI 0.90-0.94), 0.86 (95% CI 0.74-0.93) and 0.95 (95% CI 0.92-0.97), respectively. CONCLUSION: There is insufficient evidence to conclude that MRI EFW is more sensitive than 2D ultrasound AC (which is more sensitive than 2D EFW); although it was more specific. Further primary research is required before recommending MRI EFW for use in clinical practice

Contribuciones al manejo de la aloinmunización Rh

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Obstetricía y Ginecología. Fecha de lectura: 27 de Marzo de 198

Contribuciones al manejo de la aloinmunizacion Rh

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai

A Systematic Approach to First-trimester Ultrasound Assessment of Twins

The incidence of twin pregnancies has increased for the last 20 years mainly as a result of assisted reproduction technologies and pregnancies occurring in older women. Both maternal and perinatal mortality and morbidity are increased in twin pregnancies when compared with singletons. A systematic and detailed first-trimester ultrasound can be a useful tool for detecting chorionicity, growth discordance, and congenital malformations. Prediction of complications at an early stage can help with directing future management and counseling of patients