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Van den Eede E, Vergote S, Van der Veeken L, Russo F, Van der Merwe J, Mastrodima-Polychroniou S, De Catte L, Deprest J. Parental Management Choices and Discordant Ultrasound Findings in Referrals for Fetal Spina Bifida. Prenat Diagn 2024. [PMID: 39384410 DOI: 10.1002/pd.6677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/30/2024] [Accepted: 09/15/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVE The severity of spina bifida aperta can be assessed prenatally by ultrasound. Morphological findings assist parents in choosing between management options. We aimed to document those management choices since the introduction of fetal surgery, and compare initial ultrasound findings prior to referral to findings in a fetal surgery center. METHOD Single center cohort study of 245 consecutive fetuses with a second-trimester diagnosis of SBA. Data included nature of referral (for assessment or for surgery), condition-specific findings on ultrasound, and further management. We compared the reported findings on the initial ultrasound to ours for the presence of hindbrain herniation, lesion level, ventricular width, kyphosis, leg movement, and club feet. RESULTS Seventy-two percent (n = 177) of fetuses met the eligibility criteria for surgery; in 60% (n = 106) parents opted for fetal surgery. Of 136 patients specifically referred for surgery, 27 were ineligible (20%). Of the others, 93 proceeded with surgery. In up to 28% (n = 30) of surgery referrals, eligibility criteria such as lesion level (n = 30, 28%) or leg movement (72%, n = 78) as severity indicators were not reported. CONCLUSION Fetal surgery uptake was high in patients referred for surgery. Second assessment in a fetal surgery center often reveals additional relevant information.
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Affiliation(s)
- Emma Van den Eede
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
| | - Simen Vergote
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Van der Veeken
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
| | - Francesca Russo
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Johannes Van der Merwe
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - Luc De Catte
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Elizabeth Garett Anderson Institute for Women's Health, University College London, London, UK
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Sepulveda W, Garcia-Rodriguez R, Martinez-Ten P, Tonni G, Grisolia G, Meagher S. Basic sonographic examination of the fetal brain at 11-13 weeks' gestation: Rationale for a simple and reliable four-step technique. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:300-310. [PMID: 36785499 DOI: 10.1002/jcu.23337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 06/18/2023]
Abstract
The widespread incorporation of first-trimester scanning between 11 and 13 weeks' gestation has shifted from the screening of chromosomal abnormalities, mainly by measuring nuchal translucency thickness and visualization of the nasal bone, to a more detailed study of the fetal anatomy leading to early detection of several structural congenital anomalies. This goal can be improved by the routine and focused sonographic assessment of specific anatomic planes and the identification of distinctive landmarks that can help disclosing a particular, non-evident condition. In this article we present the basis for a basic, early examination of the fetal brain during screening using a four-step technique, which can be readily incorporated during the first-trimester scan. The technique includes the focused visualization of the cranial contour, choroid plexuses of the lateral ventricles and midline, aqueduct of Sylvius, brainstem, fourth ventricle, and the choroid plexus of the fourth ventricle. The rationale for this approach is presented and discussed.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Raquel Garcia-Rodriguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Pilar Martinez-Ten
- DELTA-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain
| | - Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
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Jolin-Dahel K, Cusson-Dufour C, Langlois É, Abdulnour J. Can Early First Trimester Ultrasounds Correctly Determine Gestational Age Compared to Ultrasounds Performed Between 7 to 14 Weeks Gestational Age? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:196-201. [PMID: 36716963 DOI: 10.1016/j.jogc.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends the use of an ultrasound performed between 7 and 14 weeks gestation to accurately predict gestational age (GA). This study aimed to assess the accuracy of earlier ultrasounds (5 to 66 weeks gestation) by comparing the estimated delivery dates (EDD) in participants that had undergone both an earlier ultrasound and ultrasound completed during the standard of care timeframe. METHODS EDD based on crown-rump length were retrospectively reviewed for patients that had undergone an ultrasound between 5-66 weeks GA versus the recommended 7-14 weeks GA at the Montfort Hospital during 2018 and 2019. The charts of 981 patients that had an ultrasound prior to 7 weeks GA and at 7-14 weeks GA were reviewed; 54 were included. RESULTS There was no significant difference (P = 0.307) between the EDD of the early (5-66 weeks GA) and the second ultrasound (7-14 weeks GA). The first ultrasounds were then separated into very early (5-56 weeks GA) and early (6-66 weeks GA) and compared. No significant differences (P = 0.579) were found. Similarly, no difference was found between the EDD of the early (6-66 weeks GA) and standard of care timing (P = 0.324). CONCLUSION These results show no significant difference in accurately determining the EDD between ultrasounds completed at the early and standard of care time points. This could result in cost-saving benefits by foregoing a repeat ultrasound; however, further research is required prior to applying these findings in clinical settings.
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Affiliation(s)
- Kheïra Jolin-Dahel
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON; Department of Family Medicine, Winchester District Memorial Hospital, Winchester, ON.
| | - Camille Cusson-Dufour
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON; Department of Family Medicine, Montfort Hospital, Ottawa, ON
| | - Émilie Langlois
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
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Bilardo CM, Chaoui R, Hyett JA, Kagan KO, Karim JN, Papageorghiou AT, Poon LC, Salomon LJ, Syngelaki A, Nicolaides KH. ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:127-143. [PMID: 36594739 DOI: 10.1002/uog.26106] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, and Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Hyett
- Western Sydney University, Sydney, Australia
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - J N Karim
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - L C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Paris Cité University, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Gadsbøll K, Wright A, Kristensen SE, Verfaille V, Nicolaides KH, Wright D, Petersen OB. Crown-rump length measurement error: impact on assessment of growth. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:354-359. [PMID: 33998101 DOI: 10.1002/uog.23690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/21/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the impact of first-trimester crown-rump length (CRL) measurement error on the interpretation of estimated fetal weight (EFW) and classification of fetuses as small-, large- or appropriate-for-gestational age on subsequent growth scans. METHODS We examined the effects of errors of ± 2, ± 3 and ± 4 mm in the measurement of fetal CRL on percentiles of EFW at 20, 32 and 36 weeks' gestation and classification as small-, large- or appropriate-for-gestational age. Published data on CRL measurement error were used to determine variation present in practice. RESULTS A measurement error of -2 mm in first-trimester CRL shifts an EFW on the 10th percentile at the 20-week scan to around the 20th percentile, and the effect of a CRL measurement error of + 2 mm would shift an EFW on the 10th percentile to around the 5th percentile. At 32 weeks, a first-trimester CRL measurement error would shift an EFW on the 10th percentile to the 7th (+ 2 mm) or 14th (-2 mm) percentile; at 36 weeks, the EFW would shift from the 10th percentile to the 8th (+ 2 mm) or 12th (-2 mm) percentile. Published data suggest that measurement errors of 2 mm or more are common in practice. CONCLUSION Because of the widespread and potentially severe consequences of CRL measurement errors as small as 2 mm on clinical assessment, patient management and research results, there is a need to increase awareness of the impact of CRL measurement error and to reduce measurement error variation through standardization and quality control. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Gadsbøll
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - S E Kristensen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - V Verfaille
- Ultrasound Clinic BovenMaas, Rotterdam, The Netherlands
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - O B Petersen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E1-E16. [PMID: 32852128 DOI: 10.1002/jum.15477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
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Jara-Rosales S, Fuentealba-Rivas N, Jofré-Muñoz M, Espinosa-Santos V, Godoy-Guzmán C. A new interpretation of the human embryo drawings in Icones Embryonum Humanorum by Samuel Thomas Soemmerring. Anat Sci Int 2021; 96:461-470. [PMID: 33687656 DOI: 10.1007/s12565-021-00613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
In 1799, Samuel Thomas Soemmerring published the book Icones Embryonum Humanorum, which was one of the first attempts in history to sort out prenatal human development chronologically. Despite its importance for the anatomical sciences, there is little information about Icones. In this context, our objective was to identify and estimate the developmental age of the seven human embryos present in Icones Embryonum Humanorum by external morphological analysis and morphometry of the drawings using Image-J® software. First, the book was translated from Latin. Then, the developmental age was estimated by external morphological analysis and morphometry (greatest length) of the drawings using Image-J® software. The book is composed of 20 drawings of human embryos and fetuses from two life-size tables. According to the external features and morphometric analysis, there are seven embryos (drawings I-VII). The embryonic age (pf: post-fertilization age) of drawing I corresponds to day 29-31 pf; drawing II, to day 33-35 pf; drawing III, to day 37-40 pf; drawing IV, to day 42-45 pf; drawing V, to day 45-47 pf; drawing VI, today 47-50 pf; and drawing VII, to day 52-55 pf. There are differences between the development age estimated by Soemmerring and our analysis. These differences are probably due to the methodological and technical limitations of the eighteenth century.
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Affiliation(s)
- Sergio Jara-Rosales
- Facultad de Medicina y Ciencia, Escuela de Obstetricia, Universidad San Sebastián (USS), Santiago, Chile
| | - Nora Fuentealba-Rivas
- Universidad de Santiago de Chile (USACH), Escuela de Medicina, Unidad de Histología, Centro de Investigación Biomédica y Aplicada (CIBAP), Santiago, Chile
| | - Maria Jofré-Muñoz
- Centro de Estudios Clásicos "Giuseppina Grammatico", Universidad Metropolitana de Ciencias de La Educación (UMCE), Santiago, Chile
| | | | - Carlos Godoy-Guzmán
- Universidad de Santiago de Chile (USACH), Escuela de Medicina, Unidad de Histología, Centro de Investigación Biomédica y Aplicada (CIBAP), Santiago, Chile.
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Butt K, Lim KI. Guideline No. 388-Determination of Gestational Age by Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1497-1507. [PMID: 31548039 DOI: 10.1016/j.jogc.2019.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assist clinicians in assigning gestational age based on ultrasound biometry. OUTCOMES To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with or without the use of ultrasound. To provide maternity health care providers and researchers with evidence-based guidelines for the assignment of gestational age. To determine which ultrasound biometric parameters are superior when gestational age is uncertain. To determine whether ultrasound gestational age assessment is cost effective. EVIDENCE Published literature was retrieved through searches of PubMed or MEDLINE and The Cochrane Library in 2013 using appropriate controlled vocabulary and key words (gestational age, ultrasound biometry, ultrasound dating). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to July 31, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Accurate assignment of gestational age may reduce post-dates labour induction and may improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. More accurate dating allows for optimal performance of prenatal screening tests for aneuploidy. A national algorithm for the assignment of gestational age may reduce practice variations across Canada for clinicians and researchers. Potential harms include the possible reassignment of dates when significant fetal pathology (such as fetal growth restriction or macrosomia) result in a discrepancy between ultrasound biometric and clinical gestational age. Such reassignment may lead to the omission of appropriate-or the performance of inappropriate-fetal interventions. SUMMARY STATEMENTS RECOMMENDATIONS.
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Butt K, Lim KI. Directive clinique N o 388 - Détermination de l'âge gestationnel par échographie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1508-1520. [PMID: 31548040 DOI: 10.1016/j.jogc.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Butt K, Lim K. Détermination de l'âge gestationnel par échographie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S391-S403. [PMID: 28063550 DOI: 10.1016/j.jogc.2016.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIF Aider les cliniciens à attribuer un âge gestationnel en fonction des résultats de la biométrie échographique. ISSUES Déterminer si la datation par échographie offre une évaluation plus précise de l'âge gestationnel que la datation en fonction des dernières règles avec ou sans recours à l'échographie. Offrir, aux praticiens et aux chercheurs du domaine des soins de maternité, des lignes directrices factuelles en matière d'attribution de l'âge gestationnel. Identifier les paramètres biométriques échographiques qui sont de fiabilité supérieure lorsque l'âge gestationnel est incertain. Déterminer la rentabilité de l'évaluation de l'âge gestationnel par échographie. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed ou MEDLINE et The Cochrane Library en 2013 au moyen d'un vocabulaire contrôlé et de mots clés appropriés (p. ex. « gestational age », « ultrasound biometry » et « ultrasound dating »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles rédigés en anglais. Aucune restriction n'a été appliquée en matière de dates. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'au 31 juillet 2013. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). AVANTAGES, DéSAVANTAGES ET COûTS: L'attribution précise d'un âge gestationnel pourrait réduire l'incidence du déclenchement mené en raison d'une grossesse prolongée et améliorer les soins obstétricaux en nous permettant de planifier la chronologie des interventions nécessaires de façon optimale et d'éviter les interventions inutiles. Une datation plus précise permet l'optimisation de la tenue de tests prénataux de dépistage de l'aneuploïdie. Un algorithme national d'attribution de l'âge gestationnel pourrait atténuer les variations pancanadiennes en matière de pratique pour les cliniciens et les chercheurs. Parmi les désavantages potentiels, on trouve la réattribution possible des dates lorsqu'une pathologie fœtale importante (comme le retard de croissance intra-utérin ou la macrosomie) donne lieu à une divergence entre les résultats de la biométrie échographique et l'âge gestationnel clinique. Une telle réattribution pourrait mener à l'omission d'interventions fœtales justifiées ou à la tenue d'interventions fœtales injustifiées. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Kumar M, Vajala R, Sharma K, Singh S, Singh R, Gupta U, Bhattacharjee J. First-trimester reference centiles of fetal biometry in Indian population. J Matern Fetal Neonatal Med 2016; 30:2804-2811. [PMID: 27871201 DOI: 10.1080/14767058.2016.1263890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM AND OBJECTIVE To create crown-rump length (CRL)-based biometric chart for fetus in the first trimester among the Indian population. MATERIAL AND METHODS Cross-sectional data were obtained from 400 singleton pregnancies between 11 and 14 weeks gestation with a normal outcome. Linear regression models were constructed; the mean and SD were derived as a function of CRL. RESULTS There was a positive correlation of CRL with nuchal translucency (NT) (y = 0.0102x + 0.6307 R2 = 0.1177), biparietal diameter (BPD) (BPD = 0.032*CRL +0.185 R2 = 0.765), occipito-frontal diameter (OFD), lateral ventricular diameter (LV), abdominal circumference (AC) (AC = 0.944*CRL +9.684 R2 = 0.668), femur length (FL) (FL = 0.222*CRL -4.734 R2 = 0.661), fetal weight (FW) (FW = 1.328*CRL -10.41 R2 = 0.662). The regression models and centile charts of NT, BPD, OFD, LV, AC, and FW were constructed. Taking FW as the independent variable, a linear equation of BPD, AC, and FL to calculate weight was constructed. CONCLUSIONS The first-trimester centile charts of fetal parameters can be used as a reference for Indian population in the determination of gestational age or other adverse outcomes.
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Affiliation(s)
- Manisha Kumar
- a Department of Obstetrics & Gynecology , LHMC , New Delhi , India
| | - Ravi Vajala
- b Department of Statistics, Lady Sri Ram College , New Delhi , India
| | - Karuna Sharma
- c Department of Biochemistry, LHMC , New Delhi , India
| | | | - Ritu Singh
- e Department of Biochemistry , LHMC , New Delhi , India
| | - Usha Gupta
- f Department of Obstetrics & Gynecology , LHMC , New Delhi , India
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Wylomanski S, Winer N. [Role of ultrasound in elective abortions]. ACTA ACUST UNITED AC 2016; 45:1477-1489. [PMID: 27814980 DOI: 10.1016/j.jgyn.2016.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022]
Abstract
Ultrasound plays a fundamental role in the management of elective abortions. Although it can improve the quality of post-abortion care, it must not be an obstacle to abortion access. We thus studied the role of ultrasound in pregnancy dating and possible alternatives and analyzed the literature to determine the role of ultrasound in post-abortion follow-up. During an ultrasound scan, the date of conception is estimated by measurement of the crown-rump length (CRL), defined by Robinson, or of the biparietal diameter (BPD), as defined by the French Center for Fetal Ultrasound (CFEF) after 11 weeks of gestation (Robinson and CFEF curves) (grade B). Updated curves have been developed in the INTERGROWTH study. In the context of abortion, the literature recommends the application of a safety margin of 5 days, especially when the CRL and/or BPD measurement indicates a term close to 14 weeks (that is equal or below 80 and 27mm, respectively) (best practice agreement). Accordingly, with the ultrasound measurement reliable to±5 days when its performance meets the relevant criteria, an abortion can take place when the CRL measurement is less than 90mm or the BPD less than 30mm (INTERGROWTH curves) (best practice agreement). While a dating ultrasound should be encouraged, its absence is not an obstacle to scheduling an abortion for women who report that they know the date of their last menstrual period and/or of the at-risk sexual relations and for whom a clinical examination by a healthcare professional is possible (best practice agreement). In cases of intrauterine pregnancy of uncertain viability or of a pregnancy of unknown location, without any particular symptoms, the patient must be able to have a transvaginal ultrasound to increase the precision of the diagnosis (grade B). Various reviews of the literature on post-abortion follow-up indicate that the routine use of ultrasound during instrumental abortions should be avoided (best practice agreement). If it becomes clear immediately after the procedure that the endometrial thickness exceeds 8mm, immediate reaspiration is necessary. Ultrasound examination of the endometrium several days after an instrumental elective abortion does not appear to be relevant (grade B). An analysis of the literature similarly shows that routine ultrasound scans after medical abortions should be avoided. If a transvaginal ultrasound is performed after a medical abortion, it should take place at least two weeks afterwards (best practice agreement). The only aim of an ultrasound examination during follow-up should be to determine whether a gestational sac is present (best practice agreement). Finally, if an ultrasound is performed at any point during pre- or post-abortion care, a report should be drafted, specifying any potential gynecologic abnormalities found, but its absence must not delay the scheduling of the abortion (best practice agreement).
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Affiliation(s)
- S Wylomanski
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
| | - N Winer
- Service de gynécologie-obstétrique, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Simon EG, Arthuis CJ, Haddad G, Bertrand P, Perrotin F. Biparietal/transverse abdominal diameter ratio ≤ 1: potential marker for open spina bifida at 11-13-week scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:267-272. [PMID: 24817098 DOI: 10.1002/uog.13406] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/19/2014] [Accepted: 04/25/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In the first trimester of pregnancy, a biparietal diameter (BPD) below the 5(th) percentile is a simple marker that enables the prenatal detection of half of all cases of open spina bifida. We hypothesized that relating the BPD measurement to the transverse abdominal diameter (TAD) might be another simple and effective screening method. In this study we assessed the performance of using the BPD/TAD ratio during the first trimester of pregnancy in screening for open spina bifida. METHODS A total of 20,551 first-trimester ultrasound scans (11-13 weeks' gestation), performed between 2000 and 2013, were analyzed retrospectively; there were 26 cases of open spina bifida and 17,665 unaffected pregnancies with a crown-rump length of 45-84 mm and a record of both BPD and TAD measurements. RESULTS The mean (± SD) BPD/TAD ratio was 1.00 ± 0.06 for fetuses with spina bifida and 1.13 ± 0.06 for those without (P < 0.0001). A BPD ≤ 5(th) percentile enabled the prenatal detection of 46.2% of spina bifida cases, while a BPD/TAD ratio of ≤ 1.00 detected 69.2%. If we considered cases in which either BPD was ≤ 5(th) percentile or BPD/TAD ratio was ≤ 1, we identified 76.9% of cases. In the latter case, the false-positive rate was 5.1%, while that for using a combination of both BPD ≤ 5th percentile and BPD/TAD ratio ≤ 1 was 0.6%, with a sensitivity of 38.5%. The positive predictive value of using a combination of BPD ≤ 5th percentile and BPD/TAD ratio ≤ 1 for detecting spina bifida was 8.5%. CONCLUSIONS Between 11 and 13 weeks' gestation, relating BPD to TAD improves considerably the diagnostic performance of using BPD measurement alone in screening for open spina bifida. Screening using this marker is simple and applicable to a large population.
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Affiliation(s)
- E G Simon
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France; Inserm U930, François Rabelais University, Tours, France
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Cuppen I, de Bruijn D, Geerdink N, Rotteveel JJ, Willemsen MA, van Vugt JM, Pasman JW, Roeleveld N. Small Biparietal Diameter and Head Circumference Are Part of the Phenotype instead of Independent Prognostic Markers in Fetuses with Spinal Dysraphism. Fetal Diagn Ther 2014; 37:135-40. [DOI: 10.1159/000366157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/25/2014] [Indexed: 11/19/2022]
Abstract
Objective: The aim of this retrospective study was to assess the fetal biparietal diameter (BPD) and head circumference (HC) in the second trimester of pregnancy in fetuses with open spinal dysraphism. Methods: BPD and HC were measured at 16-26 weeks in 74 fetuses with open spinal dysraphism and compared with reference values. Results: BPD was smaller in fetuses with open spinal dysraphism. Of all cases with open spinal dysraphism, 62.2% had a BPD <3rd percentile and 79.7% had a BPD <10th percentile. Of all patients, 54.1% had an HC <3rd percentile and 74.3% had an HC <10th percentile. Conclusion: Almost all fetuses with open neural tube defects have a smaller BPD and HC at 16-26 weeks compared with reference values, which implicates that this is part of the phenotype of children with open spinal dysraphism instead of an independent prognostic marker for a poor cognitive outcome.
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Sepulveda W, Wong AE, Andreeva E, Odegova N, Martinez-Ten P, Meagher S. Biparietal diameter-to-crown-rump length disproportion in first-trimester fetuses with holoprosencephaly. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1165-1169. [PMID: 24958402 DOI: 10.7863/ultra.33.7.1165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine whether the biparietal diameter measurement is altered in first-trimester fetuses with holoprosencephaly. METHODS Cases of holoprosencephaly were collected retrospectively from 4 fetal medicine centers, and first-trimester biparietal diameter measurements were reviewed. The diagnosis of holoprosencephaly was established sonographically by the detection of abnormal choroid plexus morphologic characteristics (absent "butterfly" sign) and the identification of a monoventricular cerebral cavity on axial views of the fetal brain. The proportion of fetuses with biparietal diameter measurements below the 5th percentile for crown-rump length was determined. RESULTS Among 45 cases of holoprosencephaly reviewed, 43 had information on both biparietal diameter and crown-rump length measurements. The biparietal diameter was below the 5th percentile for crown-rump length in 14 (32.6%) fetuses. Chromosomal analysis was available in 41; no statistically significant difference in biparietal diameter measurement between those with associated chromosomal anomalies and those without anomalies was noted. A supplementary analysis using head circumference measurement showed an even greater proportion of fetuses with holoprosencephaly with measurements below the 5th percentile for crown-rump length (18 of 42 [42.9%]). CONCLUSIONS One-third of first-trimester fetuses with a sonographic diagnosis of holoprosencephaly had a biparietal diameter that was smaller than expected for crown-rump length. In this subset of fetuses, the evaluation of intracranial anatomy for signs of holoprosencephaly may be more difficult to perform due to the smaller size of the brain. Therefore, the detection of a biparietal diameter below the 5th percentile as expected from crown-rump length on the first-trimester scan may be a warning sign of holoprosencephaly and should prompt a detailed examination of the intracranial anatomy.
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Affiliation(s)
- Waldo Sepulveda
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.).
| | - Amy E Wong
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.)
| | - Elena Andreeva
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.)
| | - Natalia Odegova
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.)
| | - Pilar Martinez-Ten
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.)
| | - Simon Meagher
- Fetal Medicine Center, Fetal Medicine Interest Group GIMEF, Santiago, Chile (W.S., A.E.W.); Medical-Genetics Department, Moscow Regions Research Institute of Obstetrics and Gynecology, Moscow, Russia (E.A., N.O.); Delta-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain (P.M.-T.); and Monash Ultrasound for Women, Melbourne, Victoria, Australia (S.M.)
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Butt K, Lim K, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Ouellet A, Salem S. Determination of Gestational Age by Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:171-181. [DOI: 10.1016/s1701-2163(15)30664-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Khalil A, Papageorghiou A, Bhide A, Akolekar R, Thilaganathan B. Biparietal diameter at 11 to 13 weeks' gestation in fetuses with holoprosencephaly. Prenat Diagn 2013; 34:134-8. [DOI: 10.1002/pd.4269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Aris Papageorghiou
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Amar Bhide
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Ranjit Akolekar
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
| | - Basky Thilaganathan
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology; St George's Hospital Medical School; London UK
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Sepulveda W, Wong AE. First trimester screening for holoprosencephaly with choroid plexus morphology ('butterfly' sign) and biparietal diameter. Prenat Diagn 2013; 33:1233-7. [PMID: 24018978 DOI: 10.1002/pd.4235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether choroid plexus morphology ('butterfly' sign) and biparietal diameter (BPD) are effective sonographic screening tools for holoprosencephaly (HPE) in the first trimester. METHODS An axial view of the fetal head was obtained routinely to determine the presence of the 'butterfly' sign in pregnancies presenting for sonographic screening at 11-13 weeks of gestation. The same view was also used to obtain BPD measurements. The definitive diagnosis of HPE was established by the sonographic demonstration of an anterior cerebral monoventricular cavity and thalamic fusion. RESULTS During a 9-year study period, 11 068 live fetuses were screened. There were 11 cases of HPE (prevalence 1/1006); all of them were detected by demonstration of an absent 'butterfly' sign with no false-positive cases. The BPD was less than the 5th percentile in 40% of the cases. CONCLUSIONS The 'butterfly' sign appears to be a highly sensitive marker for HPE in the first trimester. On the other hand, BPD measurements had a lower sensitivity, implying that microcephaly is not a prominent first-trimester feature in these cases. Incorporation of the 'butterfly' sign into the first trimester anatomy scan is simple and can facilitate the identification of the vast majority of fetuses with HPE in the first trimester.
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Affiliation(s)
- Waldo Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
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Khalil A, Coates A, Papageorghiou A, Bhide A, Thilaganathan B. Biparietal diameter at 11-13 weeks' gestation in fetuses with open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:409-415. [PMID: 23362051 DOI: 10.1002/uog.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/23/2012] [Accepted: 01/10/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To ascertain the reported association between reduced biparietal diameter (BPD) at 11-13 weeks' gestation and open spina bifida and to investigate its predictive value in a single-center study. METHODS This was a retrospective study of fetuses in which BPD was measured at 11-13 weeks' gestation, including 27 fetuses with isolated open spina bifida subsequently diagnosed at 16-24 weeks and 7775 unaffected controls. BPD values were converted into multiples of the expected median (MoM) after adjustment for crown-rump length and maternal characteristics. Multivariable logistic regression analysis was used to determine the maternal characteristics significantly associated with spina bifida. The performance of screening was determined by receiver-operating characteristics curve analysis. BPD values at 11-13 weeks' gestation were compared with those measured in the second trimester using Z-scores. RESULTS BPD values at 11-13 weeks' gestation were below the 5(th) centile in 44.4% of cases of open spina bifida. In these fetuses, the median BPD MoM value was significantly smaller than that in the control group (0.930 vs 0.998 MoM; P < 0.0001). Multivariable logistic regression analysis showed a significant contribution from maternal age (P = 0.008) and BMI (P = 0.028) to the association between BPD MoM and spina bifida. The detection rate using BPD measurements in the first trimester was 55.6% with a false-positive rate of 11.6%. In fetuses with open spina bifida, the BPD Z-scores were significantly lower at 16-24 weeks compared to those recorded at 11-13 weeks (median, -1.71 (range, -3.98 to -0.20) vs -1.30 (-3.75 to 2.61); P = 0.006). CONCLUSION Fetuses with open spina bifida have a smaller BPD in the first trimester. This observation may be useful in early screening. It is likely that a combination of maternal characteristics such as age and BMI, fetal BPD and maternal serum alpha-fetoprotein measured in the first trimester would provide a clinically useful screening test for open spina bifida.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Ivanovs A, Rybtsov S, Anderson RA, Turner ML, Medvinsky A. Postmenstrual gestational age should be used with care in studies of early human hematopoietic development. Blood 2013; 121:3051-2. [PMID: 23580635 DOI: 10.1182/blood-2013-01-475673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:102-13. [PMID: 23280739 DOI: 10.1002/uog.12342] [Citation(s) in RCA: 358] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Illescas T, Sepulveda W, Adiego B, Martinez-Ten P. Prenatal Detection of Fetal Anomalies at the 11- to 13-Week Scan—Part I: Brain, Face and Neck. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10009-1307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
In the last 20 years, the role of first-trimester ultrasound screening has expanded from individual calculation of the risk of aneuploidy through measurement of the nuchal translucency to a powerful technique to evaluate important aspects of the fetal anatomy. Traditionally, the full anatomy scan for detection of structural anomalies has been performed in the second trimester of pregnancy. However, with the implementation of the first-trimester scan at 11 to 13 weeks of gestation many of the structural anomalies traditionally detected in the second trimester can now be identified earlier in pregnancy. In the first part of this review we discuss the main ultrasound findings that may facilitate the prenatal detection of fetal brain, face and neck abnormalities in the first trimester of pregnancy.
How to cite this article
Sepulveda W, Illescas T, Adiego B, Martinez-Ten P. Prenatal Detection of Fetal Anomalies at the 11- to 13-Week Scan—Part I: Brain, Face and Neck. Donald School J Ultrasound Obstet Gynecol 2013;7(4):359-368.
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Bernard JP, Cuckle HS, Stirnemann JJ, Salomon LJ, Ville Y. Screening for fetal spina bifida by ultrasound examination in the first trimester of pregnancy using fetal biparietal diameter. Am J Obstet Gynecol 2012; 207:306.e1-5. [PMID: 22683101 DOI: 10.1016/j.ajog.2012.05.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 05/02/2012] [Accepted: 05/14/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Prenatal screening for aneuploidies is best achieved in the first trimester when there is no reliable screening test for spina bifida. Early ultrasound features may be too complex for routine screening. We assessed screening potential of simple and reproducible fetal biometric measurements at 11-14 weeks of gestation. STUDY DESIGN A total of 34,951 unselected consecutive pregnancies included 18 with spina bifida. Another 28 cases were referred for assessment. Biometric measurements were expressed in multiples of the median for crown-rump length. RESULTS Biparietal diameter (BPD) was smaller in spina bifida (P < .0001). In all, 22 of 44 (50%) cases with spina bifida aperta had a BPD <5th centile. BPD was independent of maternal adiposity and smoking status. CONCLUSION Simple and reproducible BPD at 11-14 weeks of gestation could detect half the cases of open fetal spina bifida by identifying 5% of pregnancies for expert scanning in first- and second-trimester examinations of the fetal spine and cranium.
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Karl K, Benoit B, Entezami M, Heling KS, Chaoui R. Small biparietal diameter in fetuses with spina bifida on 11-13-week and mid-gestation ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:140-144. [PMID: 22511513 DOI: 10.1002/uog.11175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess whether, at 11-13-week and mid-trimester ultrasound examinations, the biparietal diameter (BPD) in fetuses with open spina bifida is smaller than the reference range. METHODS In a multicenter retrospective analysis of data from 23 fetuses with open spina bifida diagnosed at 16-24 weeks, BPD at diagnosis was compared with that measured at 11-13 weeks, before diagnosis. Z-scores were calculated for comparison of BPD deviations from the reference range within the groups at 11-13 weeks and 16-24 weeks, and between these two time intervals. RESULTS BPD Z-scores at 11-13 weeks and 16-24 weeks were significantly lower (P < 0.0001) in fetuses with open spina bifida when compared to the reference range, with mean values of - 1.29 and - 2.14, respectively, corresponding to the 10(th) and 1.5(th) centiles, respectively. At 11-13 weeks only six of the 23 (26%) fetuses with open spina bifida had BPD below the 5(th) centile, in comparison to 16 (69%) at mid-gestation. This was confirmed by paired t-test comparing the first-trimester with the second-trimester BPD measurements, which showed significantly slower growth of the BPD in fetuses with spina bifida. CONCLUSION In fetuses with open spina bifida, BPD is smaller not only in the second trimester, as previously reported, but also in the first trimester. This is most likely due to loss of cerebrospinal fluid. We suggest that a BPD value < 10(th) centile in an otherwise normally grown fetus at 11-13 weeks' gestation should be considered as a potential subtle early marker for open spina bifida.
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Affiliation(s)
- K Karl
- Department of Obstetrics and Gynecology, Maistrasse, Ludwig-Maximilians-University, Munich, Germany
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Donnelly JC, Malone FD. Early fetal anatomical sonography. Best Pract Res Clin Obstet Gynaecol 2012; 26:561-73. [PMID: 22776410 DOI: 10.1016/j.bpobgyn.2012.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
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Affiliation(s)
- Jennifer C Donnelly
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland.
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Munim S, Figueras F, Shah SM, Khan F, Gardosi J. Ultrasound estimation of fetal weight: A formula for a Pakistani population. J Obstet Gynaecol Res 2010; 36:479-83. [DOI: 10.1111/j.1447-0756.2010.01169.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozat M, Kanat-Pektas M, Gungor T, Gurlek B, Caglar M. The significance of fetal sacral length in the ultrasonographic assessment of gestational age. Arch Gynecol Obstet 2010; 283:999-1004. [DOI: 10.1007/s00404-010-1510-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
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Verwoerd-Dikkeboom CM, Koning AHJ, Hop WC, Rousian M, Van Der Spek PJ, Exalto N, Steegers EAP. Reliability of three-dimensional sonographic measurements in early pregnancy using virtual reality. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:910-916. [PMID: 18792418 DOI: 10.1002/uog.5390] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To establish the reliability of three-dimensional (3D) ultrasound measurements in early pregnancy using a virtual reality system (the Barco I-Space). METHODS The study included 28 pregnancies with gestational ages ranging from 6 to 14 (median, 10) weeks. 3D volumes were acquired and offline measurements were made, where possible, of the yolk sac diameter, crown-rump length, biparietal diameter, head circumference and abdominal circumference, using specialized 3D imaging software (4D View). The datasets were then transferred to the Barco I-Space, a virtual reality system that allows the observer to perceive depth and interact with volume-rendered (ultrasound) data. The 3D rendered volumes were measured using a virtual pointer, controlled by a wireless joystick. For intraobserver variability, 3D and virtual reality volumes were measured twice by one operator. For interobserver variability, another operator performed the same measurements once. All measurements were repeated three times and their mean values were used for comparisons. RESULTS All intraclass correlation coefficients (ICCs) comparing 4D View measurements with I-Space measurements were > 0.97. Intra- and interobserver ICCs for the 4D View measurements were > 0.96 and for the I-Space ones were > 0.98, representing good agreement. CONCLUSIONS The application of virtual reality is a novel method of visualizing 3D ultrasound data and perception of the depth in the I-Space offers possibilities for measuring non-planar structures. We have demonstrated that early pregnancy measurements in the I-Space are reliable. New areas of embryonic and fetal biometry can now be explored using this technique, which we tentatively name 'virtual embryoscopy'.
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Affiliation(s)
- C M Verwoerd-Dikkeboom
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Verwoerd-Dikkeboom CM, Koning AHJ, van der Spek PJ, Exalto N, Steegers EAP. Embryonic staging using a 3D virtual reality system. Hum Reprod 2008; 23:1479-84. [PMID: 18296447 DOI: 10.1093/humrep/den023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to demonstrate that Carnegie Stages could be assigned to embryos visualized with a 3D virtual reality system. METHODS We analysed 48 3D ultrasound scans of 19 IVF/ICSI pregnancies at 7-10 weeks' gestation. These datasets were visualized as 3D 'holograms' in the BARCO I-Space virtual reality system. Embryos were staged according to external morphological features (i.e. mainly limb development). After staging, the crown rump length (CRL) was measured. Stage and CRL were compared with gestational age based on the date of oocyte retrieval and with the classical data on embryology from the Carnegie Collection. RESULTS Embryonic staging was relatively easy because the I-Space allows depth perception, which helps in the estimation of size and position. The presumed stages corresponded well with the measured CRL. However, in 28 out of 48 cases, the stages seemed to have been reached earlier than previously described for the Carnegie Collection. CONCLUSIONS The I-Space, tentatively named Virtual Embryoscopy, is a promising non-invasive tool for early pregnancy evaluation. Combining embryonic growth with embryonic development opens a new area to study the relationship between embryonic growth, development and morphology, as well as second and third trimester pregnancy complications.
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Affiliation(s)
- C M Verwoerd-Dikkeboom
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, PO Box 2040, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, The Netherlands.
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Chen M, Lee CP, Lam YH, Ou CQ, Tang MHY. First-trimester fetal limb biometry in Chinese population. Prenat Diagn 2007; 27:133-8. [PMID: 17154337 DOI: 10.1002/pd.1629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To establish reference ranges for fetal limb biometry obtained by transabdominal ultrasound examination at 12-14 weeks of gestation in Chinese women. METHODS A total of 1489 normal singleton fetuses between 12(+0) and 14(+6) weeks of gestation were examined transabdominally by two experienced observers. The gestation was ascertained by measurement of fetal crown-rump length (CRL) or biparietal diameter (BPD) and head circumference (HC). The lengths of the humerus and femur were prospectively worked out. RESULTS Gestation-specific reference ranges for limb measurements were calculated. The femur length (FL) (mean +/- SD) was 9.15 +/- 1.44 mm at 12-12(+6) weeks, 11.45 +/- 1.35 mm at 13-13(+6) weeks, and 13.64 +/- 1.60 mm at 14-14(+6) weeks; the corresponding humerus length (HL) (mean +/- SD) was 9.63 +/- 1.44 mm, 12.01 +/- 1.41 mm, 14.29 +/- 1.48 mm, respectively. CONCLUSIONS There was a general increase in fetal limb biometry with gestation. Fetal limb length can be an early marker of early growth restriction as well as fetal skeletal dysplasia among women in the local population.
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Affiliation(s)
- Min Chen
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Salomon LJ, Bernard JP, Ville Y. Le contrôle de qualité en échographie prénatale : intérêt de la biométrie. ACTA ACUST UNITED AC 2006; 34:683-91. [PMID: 16959525 DOI: 10.1016/j.gyobfe.2006.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 07/25/2006] [Indexed: 10/24/2022]
Abstract
Because of an increasing demand for limited health care resources as well as an increasing impact of legal aspects in ultrasound practice, it has become necessary to ensure that screening procedures are cost-effective and clinically effective and to develop systems that could help sonographists in certifying their practice. Based on the literature, various approaches for quality control are reviewed. Special emphasis is put on the use of fetal biometry and statistical tools to develop quality control systems based on both qualitative and quantitative approach. Besides their potentials for audit and quality control, such tools could also be useful during the process of training.
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Affiliation(s)
- L-J Salomon
- Service de gynécologie-obstétrique, CHI de Poissy-Saint-Germain, 10, rue Champ-Gaillard, 78300 Poissy, France.
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Salomon LJ, Cavicchioni O, Bernard JP, Duyme M, Ville Y. Growth discrepancy in twins in the first trimester of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:512-6. [PMID: 16145648 DOI: 10.1002/uog.1966] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The prevalence and significance of intertwin growth discrepancy in the first trimester of pregnancy are controversial. The aim of this study was to refine the incidence and outcome of this discrepancy in relation to dating of the pregnancy and other biometric parameters. METHODS This prospective study of twin pregnancies initially evaluated at 11-14 weeks' gestation was conducted between 2001 and 2004. Differences in crown-rump length (CRL) and estimated gestational age (GA) were calculated for each twin pair and their distribution was analyzed according to chorionicity and mode of conception (spontaneous or following assisted reproductive technologies). CRL-based GA and actual GA were compared. Other biometric parameters were also compared for each twin pair. The distribution of discrepancies was analyzed according to pregnancy outcome. RESULTS A total of 182 twin pregnancies was included. The mean+/-SD discrepancy in CRL was 3.4+/-3.18 mm or 5.1+/-4.69% and the 95th centile was 9.8 mm or 14.3%. There was no influence of chorionicity (P=0.44), mode of conception (P=0.18) and no relation with outcome (P=0.54). In conceptions resulting from assisted technology, the measured CRL of the smaller twin was closer to the actual GA. Cephalic and abdominal biometric measurements were significantly greater in the twin with the smaller CRL (P<0.05). The two cases with a discrepancy>15 mm were affected by trisomy 18 and triploidy, respectively. CONCLUSIONS CRL discrepancy in twin pregnancies in the first trimester is a frequent finding. Discrepancy>95th centile indicates major growth delay of one twin, which could indicate the presence of aneuploidy. For milder degrees of discordance the CRL of the smaller fetus is a more accurate estimate of the actual GA.
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Affiliation(s)
- L J Salomon
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal de Poissy-St Germain, Poissy, France
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Salomon LJ, Bernard JP, Nizard J, Ville Y. First-trimester screening for fetal triploidy at 11 to 14 weeks: a role for fetal biometry. Prenat Diagn 2005; 25:479-83. [PMID: 15966039 DOI: 10.1002/pd.1170] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intrauterine growth restriction in triploidy has been reported as early as in the first trimester. This study was undertaken to evaluate the ability of first-trimester crown rump length (CRL)-based charts to detect triploid fetuses. MATERIAL AND METHODS Analysis of fetal biometry in cases of triploidy diagnosed in the first trimester over the last three years. Biometry for abdominal circumference (AC), head circumference (HC) and biparietal diameter (BPD) was analyzed in relation to both gestational age (GA)-based charts and to CRL-based charts. RESULTS Five cases of fetal triploidy were diagnosed at 11 to 14 weeks. Screening based on nuchal translucency (NT) and maternal age showed a risk > 1/300 in only one of the 5 cases of triploid fetus. In all of these five cases, CRL-based biometry was grossly abnormal, although it was abnormal in only two of these five cases in relation to GA-based charts. CONCLUSION First-trimester CRL-based biometry charts seem to reflect early asymmetrical growth delay in triploidy more accurately than GA-based charts. CRL-based biometry is likely to improve the early detection of triploid pregnancies without leading to dating error.
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Affiliation(s)
- L J Salomon
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal de Poissy-St Germain, 10 rue Champ Gaillard, Poissy, France
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Salomon LJ, Bernard JP, Ville Y. [First trimester ultrasound should be a tailored examination]. ACTA ACUST UNITED AC 2004; 33:375-7. [PMID: 15480275 DOI: 10.1016/s0368-2315(04)96543-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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